Qunibi Wajeh Y
Nephrology Division, Department of Medicine, University of Texas Health Science Center, San Antonio, Texas 78229, USA.
Semin Dial. 2007 Mar-Apr;20(2):134-8. doi: 10.1111/j.1525-139X.2007.00260.x.
Chronic kidney disease (CKD) has become a major health-care problem of global proportions. Progression to end-stage renal disease (ESRD), the need for renal replacement therapy, and the high annual death rate of dialysis patients are the most noticeable outcomes of CKD. Less appreciated, however, is the fact that most patients with CKD actually die mainly from cardiovascular disease, rather than progress to ESRD. Coronary artery calcification (CAC), a surrogate marker of atherosclerosis, is common in dialysis and CKD patients. Coronary artery calcium scores, as measured by ultrafast computed tomography, is an independent predictor of future cardiac events. Using this technique, several studies have documented extensive calcification in dialysis patients, a subject of several exhaustive reviews. Unfortunately, much less attention has been paid to calcification in nondialyzed patients with CKD. In this review, I will emphasize the fact that CVC is common in patients with CKD not yet on dialysis, develops early in the course of CKD, and worsens with the decline in renal function particularly among diabetics who progressed to ESRD. I will also discuss the pathogenesis of CVC in CKD patients and highlight the lack of a major role for abnormalities of mineral metabolism in the pathogenesis of calcification in CKD patients. In addition to the high prevalence of traditional risk factors for CAD, the presence of proteinuria, reduced renal function, diabetic nephropathy, and the rate of progression to ESRD may represent the main uremia-related factors that increase the risk for calcification in CKD. Finally, I will review the protective role of inhibitors of calcification in CKD.
慢性肾脏病（CKD）已成为一个具有全球规模的重大医疗保健问题。进展至终末期肾病（ESRD）、对肾脏替代治疗的需求以及透析患者的高年死亡率是CKD最显著的后果。然而，较少受到重视的是，大多数CKD患者实际上主要死于心血管疾病，而非进展为ESRD。冠状动脉钙化（CAC）是动脉粥样硬化的替代标志物，在透析患者和CKD患者中很常见。通过超速计算机断层扫描测量的冠状动脉钙化积分是未来心脏事件的独立预测指标。利用这项技术，多项研究记录了透析患者中广泛的钙化情况，这一主题已有多篇详尽的综述。不幸的是，对于未透析的CKD患者的钙化情况关注较少。在本综述中，我将强调以下事实：CKD尚未透析的患者中冠状动脉钙化很常见，在CKD病程早期就会出现，并随着肾功能下降而恶化，尤其是在进展为ESRD的糖尿病患者中。我还将讨论CKD患者冠状动脉钙化的发病机制，并强调矿物质代谢异常在CKD患者钙化发病机制中并非主要作用。除了CAD传统危险因素的高患病率外，蛋白尿的存在、肾功能降低、糖尿病肾病以及进展为ESRD的速率可能代表了增加CKD患者钙化风险的主要尿毒症相关因素。最后，我将综述钙化抑制剂在CKD中的保护作用。
