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Blood Purif 2005;23:203–210

Why Do Dialysis Patients Develop a Heart of Stone and Bone of China?

Martola L. · Barany P. · Stenvinkel P.
Division of Renal Medicine, Department of Clinical Science, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
email Corresponding Author

 goto top of outline Key Words

  • Adynamic bone disease
  • Calcification, arteries and heart valves
  • Calcification process, uremic risk factors
  • End-stage renal disease
  • Mineral metabolism disturbances
  • Osteogenesis
  • Vascular calcification
  • Inflammation

 goto top of outline Abstract

Vascular calcification is a common complication of end-stage renal disease (ESRD). The mechanisms responsible are complex and have so far been considered to be mainly the result of a passive mechanism due to elevated PO4 levels and high Ca × PO4 ion product resulting in saturated plasma. However, recent results suggest that also other features, commonly observed in the uremic milieu, such as chronic inflammation, hyperleptinemia and a dysregulation of various mineral-regulating proteins might also contribute to an enhanced calcification process. Moreover, as an inverse relationship between vascular calcification and bone density has been documented in ESRD, it could be speculated that pathologically low bone remodelling (adynamic bone disease) associated with active vitamin D treatment and low parathyroid hormone (PTH) levels may predispose to ectopic calcification of vessels, valves and heart. As patients with vascular calcification have a higher intake of calcium-containing PO4 binders, novel, non-calcium containing PO4 binders may diminish the risk of progressive vascular calcification in this patient group. Further studies are needed to elucidate the respective role of chronic inflammation, hyperleptinemia and PTH-lowering therapies in this fatal complication of ESRD.

Copyright © 2005 S. Karger AG, Basel

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 goto top of outline Author Contacts

Peter Stenvinkel, MD, PhD
Department of Renal Medicine K56, Karolinska Institutet
Karolinska University Hospital at Huddinge
SE–141 86 Stockholm (Sweden)
Tel. +46 8 5858 2532, Fax +46 8 7114742, E-Mail

 goto top of outline Article Information

Accepted: December 1, 2004
Published online: April 4, 2005
Number of Print Pages : 8
Number of Figures : 2, Number of Tables : 1, Number of References : 80

 goto top of outline Publication Details

Blood Purification

Vol. 23, No. 3, Year 2005 (Cover Date: 2005)

Journal Editor: Leunissen, K.M.L. (Maastricht)
ISSN: 0253–5068 (print), 1421–9735 (Online)

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