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Cardiac calcification in renal patients: what we do and don't know
Nabil M A Hujairi1, Behdad Afzali, David J A Goldsmith
1Renal and Transplantation Unit, Guy's Hospital, London, UK.
Insights
Cardiovascular disease is a major cause of death in renal patients, often linked to cardiovascular calcification (CVC). Further research is needed to understand CVC pathogenesis and guide interventions for better patient outcomes.
Area of Science:
- Nephrology
- Cardiology
- Medical Imaging
Background:
- Cardiovascular disease is a leading cause of mortality in patients with renal diseases.
- Renal patients exhibit increased cardiovascular calcification (CVC) compared to the general population.
- Risk factors include hypertension, dyslipidemia, and chronic inflammation, but CVC's link to mortality remains unclear.
Purpose of the Study:
- To review 10 studies on renal patients using modern cardiovascular calcification (CVC) imaging techniques.
- To identify potential targets for future interventional studies regarding CVC in renal disease.
Main Methods:
- Systematic review of 10 observational studies.
- Utilized modern cardiovascular calcification (CVC) imaging and quantification techniques.
- Focused on renal patient populations.
Main Results:
- Cross-sectional studies indicate excess CVC in renal patients.
- Factors like dialysis duration, dyslipidemia, and altered calcium-phosphorus metabolism are associated with increased CVC.
- A definitive link between CVC and subsequent mortality requires further investigation.
Conclusions:
- Understanding the pathogenesis of CVC in renal patients is crucial.
- Current knowledge is insufficient for robust recommendations on care strategies.
- Future interventional studies targeting CVC in renal disease are warranted.
Abstract:
Cardiovascular (CV) disease is one of the major causes of mortality in patients with renal diseases, with an increased odds ratio of mortality with risk factors as diverse as blood pressure (high or low), cholesterol level (high or low), left ventricular hypertrophy, vascular stiffness, chronic inflammation, and hyperhomocysteinemia. Mainly cross-sectional studies of renal patients showed excess CV calcification (CVC) compared with the general population, but a clear link between calcification and subsequent mortality is tenuous to date. Several factors have been incriminated to explain the increase in CVC in this particular population. Increased duration of dialysis therapy, dyslipidemia, altered calcium-phosphorus metabolism, and chronic inflammation have all been associated with increased CVC. However, with the shortage of large, observational, population-based, prospective studies tracking these potential risk factors and the pathogenesis of CVC in renal patients not yet sufficiently understood, it is difficult with the present state of knowledge to make robust recommendations about care strategies. The purpose of this review is to examine the 10 available studies of renal patients that have used modern CVC imaging and quantification techniques for clues to likely targets for future interventional studies.
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