Related Experiment Videos
[Study on vascular calcification in patients on continuous ambulatory peritoneal dialysis (CAPD): special reference
1Second Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
Insights
Vitamin D (VD) administration in patients on chronic peritoneal dialysis (CAPD) may worsen vascular calcification (VC). This study suggests conventional VD therapy might increase aortic calcification risk in long-term CAPD patients.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Context:
- Cardiovascular complications, particularly vascular calcification (VC), are a significant concern for patients undergoing chronic dialysis.
- Altered calcium and phosphate metabolism are implicated in VC pathogenesis, but contributing factors remain unclear.
Purpose:
- To investigate the factors contributing to vascular calcification in patients undergoing chronic peritoneal dialysis (CAPD).
- To explore the progression of VC in CAPD patients receiving long-term vitamin D (VD) treatment.
Summary:
- 38 CAPD patients were divided into groups based on aortic calcification presence; elderly patients and longer CAPD duration were noted in the calcified group.
- A subgroup analysis of 22 VD-treated versus non-treated CAPD patients revealed a significantly higher prevalence of aortic calcification in the non-treated group (7/11 vs. 2/11, P < 0.05).
- Despite no significant differences in lipids, mineral, or endocrinological parameters, conventional VD administration may enhance VC in long-term CAPD patients.
Impact:
- Findings suggest that conventional vitamin D administration might inadvertently promote vascular calcification in patients on long-term CAPD.
- This highlights a potential paradox in VD therapy for dialysis patients and warrants further investigation into optimal treatment strategies.
Abstract:
Cardiovascular complications, such as vascular calcification (VC), have been a major concern in patients undergoing chronic dialysis. The pathogenesis of this VC has been attributed to the altered calcium and phosphate metabolism, but the contributing factors have not been clarified. In order to investigate these factors, 38 CAPD patients were divided into two sub-groups according to the absence of aortic calcification (Group-A; n = 18) or the presence of aortic calcification (Group-B; n = 20). The number of elderly patients was larger and the duration of CAPD was longer in Group-B than in Group-A. Calcium and phosphate metabolism and serum lipids levels did not differ significantly between groups and the number of patients given VD was 8/18 in Group-A and 14/20 in Group-B. In order to explore the progression of VC in CAPD patients given long-term treatment with VD, 22 patients who were matched for the duration of CAPD were analyzed. These were divided into two sub-groups according to whether they were treated with VD (Group-C; n = 11) or not treated with VD (Group-D; n = 11). Radiological findings (such as the degree of aortic calcification), bone mineral content, divalent ions, parathyroid hormone levels and lipid profiles were examined. The prevalence of patients with aortic calcification was significantly higher in Group-D than in Group-C (7/11 v. s. 2/11, P < 0.05). However, lipids, mineral and endocrinological parameters did not differ between the sub-groups. No significant difference in the calcium and phosphate balance was observed. The bone mineral content revealed no difference between both of the sub-groups. VD administration by conventional mode, even without significant suppression of PTH or increase of bone mineral content, may enhance vessel calcification in patients on long-term CAPD.