Extramedullary calcification of CKD-MBD and How to Calculate

At the annual meeting of the American Society of Renal Diseases (ASN) in 2013, the content of chronic kidney disease-mineral and bone abnormalities (CKD-MBD) was one of the important topics of this annual meeting. Prof. Raggi of Canada and Associate Professor Jamal gave speeches entitled "Abnormal burden of external bone calcification" and "An endocrine expert's opinion on calcium supplementation", Bellasiji, Italy, Professor of CKD-MBD, bone - mineral metabolic disorders in patients with cardiovascular prognosis of the impact of a focus on the introduction.

The extracurricular burden of extracorporeal calcification

Mineral and bone abnormalities are an early threat to CKD, and vascular calcification is an important issue. CKD vascular calcification, including atherosclerosis and uremic arterial lesions, can now be through the multi-slice spiral CT and electron beam CT arterial lesions for fine detection.

Vascular calcification predicts increased risk of death Clinical studies have shown that older patients with hemodialysis have higher levels of coronary artery calcification (CAC) than those with non-dialysis, no coronary artery disease, and young patients with CKD by high-resolution electron beam computed tomography (CT). A 6-year study of 166 patients with maintenance hemodialysis found that CAC scores were an independent predictor of death in hemodialysis patients, with all-cause deaths from 1 to 100, 101 to 400, and> 400 Rates were 18.7%, 32.1% and 41.7% respectively. Block and other studies have found that CAC score is still a new predictor of all-cause death in hemodialysis patients.

French scholar studies have also shown that vascular calcification is a predictor of cardiovascular death and all-cause death in patients with end-stage renal disease, with 73% mortality in carotid, abdominal aorta, iliac femoral and calf arteries The

Prevention of vascular calcification A randomized controlled study (RCT) in the United States showed that compared with conventional calcium, non-calcium-containing phosphate binders, stilamil, reduced coronary artery and aortic calcification in hemodialysis patients.

Further studies have also found that the presence of coronary artery calcification in the presence of coronary artery calcification (even mildly) in patients with newly diagnosed hemodialysis is more pronounced. "Lancet" magazine in October this year, published a meta-analysis of the article pointed out that compared with the use of calcium-containing phosphorus binding agent, non-calcium-containing combination of CKD patients with all-cause mortality decreased by 22%.

For non-dialysis CKD patients, new studies have shown that compared with the Siwei Lahu treatment group, low-phosphorus diet group and calcium-phosphorus-binding treatment group were compared before the study (2 years) of total coronary calcification integral (TCS) Significantly improved (P values ​​were less than 0.001).

ADVANCE study observed the effect of calcium-sensitive receptor agonist cinacalcet plus small doses of vitamin D on hemodialysis in patients with CKD treated with hemodialysis. The results showed that compared with vitamin D alone, Cassay small doses of vitamin D can reduce the calcification of blood vessels (aorta) and heart valves (aortic and tricuspid).

For the parathyroid subtotal resection can reduce the mortality of dialysis patients, the recent US scholars on the clinical data analysis showed that the average follow-up after 3.6 years, parathyroid subtotal resection can reduce hemodialysis patients all-cause long-term (P = 0.006). Compared with the non-surgical approach, parathyroid subtotal resection reduced the risk of all-cause mortality and 33% of cardiovascular mortality.

An endocrine expert on the views of calcium

For a long time, calcium-calcium-binding agent is widely used in the treatment of CKD-MBD hyperphosphatemia, so calcium supplement on the human body's benefits and damage should be the correct understanding of kidney physicians.

Calcium Effects on Bone The results of a study in New Zealand a five-year follow-up study showed that for the daily supplementation of calcium citrate 1000 mg of healthy postmenopausal women (age 74 ± 4 years), the blood alkaline phosphatase and type Ⅰ Pre-collagen levels decreased significantly, suggesting that calcium supplement can cause abnormal bone metabolism.

In a 19-year prospective cohort study in Sweden, a follow-up study of 61433 women over 50 years of age was analyzed. The results showed that calcium intake (800 mg per day) was associated with fracture and bone Loose disease has nothing to do.

A recent meta-analysis of the American scholar confirms that calcium intake has nothing to do with the risk of hip fractures, among which four RCT studies have shown that supplementing 800 to 1600 mg of calcium per day may increase the risk of hip fractures.

The RCT study published in the New England Journal of Medicine in 1997 showed that calcium supplementation did not prevent bone loss in lactating women and only slightly increased bone mineral density in women after weaning.

In 2006, the New England Journal of Medicine published an RCT study entitled "Supplemental Calcium plus Vitamin D3 and Risk of Fracture", and 36,282 postmenopausal women (aged 50-79 years) received a 7-year follow-up. The results showed that 1000 mg of calcium carbonate plus 400 IU of vitamin D3 could increase the hip bone mineral density in healthy postmenopausal women, but could not reduce the risk of hip fracture and increase the risk of kidney stones.

Calcium supplementation may increase cardiovascular risk 2008 In an RCT study published in the British Journal of Medicine, 1471 postmenopausal women (mean age 74 years) older than 55 years were enrolled in the study, with an average follow-up 5 years, the results show that compared with the placebo group, supplemented with 1000 mg of calcium citrate daily healthy menopausal women, the incidence of cardiovascular events increased.

In 2010, a meta-analysis published in the British Medical Journal entitled "Effects of Calcium on Myocardial Infarction and Cardiovascular Events" showed that calcium supplementation (not supplemented with vitamin D3 at the same time) was associated with an increased risk of myocardial infarction Correlated (P = 0.035).

For supplementation of calcium in patients with CKD, Jamal Associate Professor concluded that the total amount of calcium intake per day does not exceed 1200 mg, and that if there are cardiovascular disease patients should be less; calcium from dietary sources is the best supplement; if calcium is used Use low solubility and take after meals; if the purpose of prevention of fractures, to be used has been proven effective anti-fracture effect of the measures.