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[Recent advances in the prevention of cardiovascular morbidity and mortality in end-stage renal disease: role of anemia, hyperparathyroidism and calcifications].
G Ital Nefrol 2007 Sep-Oct; 24 Suppl 38:25-32GI

Abstract

The mortality rate in patients with end-stage renal disease (ESRD) is extremely high, mainly because of the high prevalence of cardiovascular disease. In addition to traditional cardiovascular risk factors, other factors peculiar to chronic kidney disease play a role. Anemia and calcium-phosphate disorders are of particular interest, not only because they have been related to an increased risk of death but, more importantly, because they can be reversed by treatment, thereby providing the opportunity to prevent or delay the onset of cardiovascular disease. Despite a clear association between higher hemoglobin levels and better survival, data from interventional trials do not seem to show a significant positive effect of hemoglobin normalization with erythropoiesis-stimulating agents on survival and left ventricular mass in ESRD patients. Nevertheless, partial correction of anemia is still an important goal to be reached, as is also suggested by international guidelines. Disorders of calcium-phosphate metabolism have also been clearly related to increased mortality. Unlike anemia, which can be easily corrected by treatment in most cases, mineral metabolism is much less effectively treated. New agents, such as phosphate binders not containing calcium and aluminum, vitamin D analogs with lower calcemic activity, and calcimimetics, are becoming increasingly available in everyday clinical practice and are likely to allow a higher percentage of patients to achieve the recommended targets for calcium-phosphate and parathyroid hormone. Given that these molecules have only been introduced recently, clear data from interventional studies showing improved survival after adequate correction of mineral metabolism parameters are still lacking.

Authors+Show Affiliations

UF d'Ipertensione e Nefrologia Preventiva, IRCCS Multimedia, Sesto San Giovanni (MI), Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article

Language

ita

PubMed ID

17922444

Citation

Del Vecchio, L, et al. "[Recent Advances in the Prevention of Cardiovascular Morbidity and Mortality in End-stage Renal Disease: Role of Anemia, Hyperparathyroidism and Calcifications]." Giornale Italiano Di Nefrologia : Organo Ufficiale Della Societa Italiana Di Nefrologia, vol. 24 Suppl 38, 2007, pp. 25-32.
Del Vecchio L, Pozzoni P, Limardo M, et al. [Recent advances in the prevention of cardiovascular morbidity and mortality in end-stage renal disease: role of anemia, hyperparathyroidism and calcifications]. G Ital Nefrol. 2007;24 Suppl 38:25-32.
Del Vecchio, L., Pozzoni, P., Limardo, M., Caruso, S., Fortunato, M., Pontoriero, G., & Locatelli, F. (2007). [Recent advances in the prevention of cardiovascular morbidity and mortality in end-stage renal disease: role of anemia, hyperparathyroidism and calcifications]. Giornale Italiano Di Nefrologia : Organo Ufficiale Della Societa Italiana Di Nefrologia, 24 Suppl 38, pp. 25-32.
Del Vecchio L, et al. [Recent Advances in the Prevention of Cardiovascular Morbidity and Mortality in End-stage Renal Disease: Role of Anemia, Hyperparathyroidism and Calcifications]. G Ital Nefrol. 2007;24 Suppl 38:25-32. PubMed PMID: 17922444.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Recent advances in the prevention of cardiovascular morbidity and mortality in end-stage renal disease: role of anemia, hyperparathyroidism and calcifications]. AU - Del Vecchio,L, AU - Pozzoni,P, AU - Limardo,M, AU - Caruso,S, AU - Fortunato,M, AU - Pontoriero,G, AU - Locatelli,F, PY - 2007/12/6/pubmed PY - 2010/3/6/medline PY - 2007/12/6/entrez SP - 25 EP - 32 JF - Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia JO - G Ital Nefrol VL - 24 Suppl 38 N2 - The mortality rate in patients with end-stage renal disease (ESRD) is extremely high, mainly because of the high prevalence of cardiovascular disease. In addition to traditional cardiovascular risk factors, other factors peculiar to chronic kidney disease play a role. Anemia and calcium-phosphate disorders are of particular interest, not only because they have been related to an increased risk of death but, more importantly, because they can be reversed by treatment, thereby providing the opportunity to prevent or delay the onset of cardiovascular disease. Despite a clear association between higher hemoglobin levels and better survival, data from interventional trials do not seem to show a significant positive effect of hemoglobin normalization with erythropoiesis-stimulating agents on survival and left ventricular mass in ESRD patients. Nevertheless, partial correction of anemia is still an important goal to be reached, as is also suggested by international guidelines. Disorders of calcium-phosphate metabolism have also been clearly related to increased mortality. Unlike anemia, which can be easily corrected by treatment in most cases, mineral metabolism is much less effectively treated. New agents, such as phosphate binders not containing calcium and aluminum, vitamin D analogs with lower calcemic activity, and calcimimetics, are becoming increasingly available in everyday clinical practice and are likely to allow a higher percentage of patients to achieve the recommended targets for calcium-phosphate and parathyroid hormone. Given that these molecules have only been introduced recently, clear data from interventional studies showing improved survival after adequate correction of mineral metabolism parameters are still lacking. SN - 0393-5590 UR - https://www.unboundmedicine.com/medline/citation/17922444/[Recent_advances_in_the_prevention_of_cardiovascular_morbidity_and_mortality_in_end_stage_renal_disease:_role_of_anemia_hyperparathyroidism_and_calcifications]_ L2 - http://www.diseaseinfosearch.org/result/441 DB - PRIME DP - Unbound Medicine ER -