Special report: controversies in bone and mineral metabolism in chronic kidney diseaseVascular calcification in chronic kidney disease
Section snippets
what we know…
There are 2 distinct types of arterial calcification.2, 3 One affects the intimal layer of arteries and occurs within atherosclerotic plaques. The other involves the medial wall, or tunica media, of arteries. The second type of vascular calcification is common in patients with CKD and those with diabetes mellitus. The consequences of each form of arterial calcification differ fundamentally.
The manifestations of atherosclerotic vascular disease are well established both in the general population
what we need to know…
Recent observations linking disturbances in calcium and phosphorus metabolism to adverse clinical outcomes emphasize the need to better understand the impact of current therapeutic strategies for renal osteodystrophy on mineral metabolism in patients with CKD.7, 12, 20, 32, 62, 63 Although much is known about the physiology and regulation of intestinal calcium transport, additional information about the efficiency of intestinal calcium absorption at various stages of CKD is needed. More
what we should do with what we know…
The extraordinary risk of cardiovascular disease and the prominent role of vascular calcification as a component of it argue strongly that measures be implemented to detect vascular calcification in patients undergoing dialysis as well as in those with less advanced kidney disease. Some have suggested that these assessments be done annually in all patients with CKD, stages 2 to 5. The primary objectives of such screening are to offer a preliminary assessment of risk for individual patients and
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