Phosphorus restriction and control of coronary calcification as assessed by electron beam tomography.

Abstract

Patients suffering from end-stage renal disease and undergoing dialysis demonstrate extremely elevated cardiovascular morbidity and mortality rates. Though the prevalence of traditional risk factors is very high, the extent and severity of cardiovascular complications seem disproportionate to the underlying risk profile. A growing body of evidence indicates that abnormalities of calcium and phosphorus metabolism may play an important role in the morbidity and mortality of end-stage renal disease patients. Calcification of several cardiovascular structures, a likely complication of hyperphosphatemia and excessive calcium load, is both highly prevalent and extensive in end-stage renal disease patients and carries a negative prognostic weight. The extent of calcification can be accurately quantified with noninvasive radiological techniques such as electron beam tomography. Utilizing electron beam tomography in patients undergoing dialysis it has been possible to demonstrate the rapid progression of cardiovascular calcification and to gauge the effect of treatment provided to slow such process. The presence of deleterious cardiovascular calcification in end-stage renal disease can be diagnosed accurately and noninvasively with electron beam tomography. This technology also allows precise assessment of the effect of medical treatment for hyperphosphatemia on calcification of cardiovascular structures.