Ishimura Eiji, Okuno Senji, Taniwaki Hiromichi, Kizu Akane, Tsuchida Takao, Shioi Atsushi, Shoji Tetsuo, Tabata Tsutomu, Inaba Masaaki, Nishizawa Yoshiki
Osaka City University Graduate School of Medicine, Osaka, Japan.
Kidney Blood Press Res. 2008;31(1):10-5. doi: 10.1159/000112542. Epub 2007 Dec 19.
Vascular calcification is highly prevalent in dialysis patients, and significantly increases cardiovascular mortality. The presence and progression of vascular calcification is significantly associated with chronic inflammation and malnutrition. Disorders of mineral metabolism, particularly hyperphosphatemia, have been emphasized as risk factors for vascular calcification. Although vascular calcification has been reported to be highly prevalent in diabetic patients with end-stage renal disease (ESRD), the risk factors for vascular calcification in these patients have not been fully explored. Through a review of the literature and our recent studies examining vascular calcification in ESRD patients, hyperphosphatemia is significantly associated with vascular calcification in nondiabetic ESRD patients, while it may not be a significant risk factor for vascular calcification in diabetic ESRD patients. In diabetic patients, vascular calcification occurs long before the initiation of dialysis therapy, and the factors associated with vascular calcification in non-uremic diabetics appear to be hyperglycemia and related metabolic disorders, such as increased glycation and oxidative stress. In diabetic ESRD patients, hyperglycemia is also suggested to be a significant factor associated with the progression of vascular calcification. Thus, the importance of glycemic and phosphate control is suggested to be emphasized in diabetic and nondiabetic ESRD patients, respectively, for prevention of the progression of vascular calcification.
血管钙化在透析患者中极为普遍，且显著增加心血管疾病死亡率。血管钙化的存在与进展与慢性炎症和营养不良显著相关。矿物质代谢紊乱，尤其是高磷血症，已被视为血管钙化的危险因素。尽管据报道血管钙化在终末期肾病（ESRD）糖尿病患者中极为普遍，但这些患者血管钙化的危险因素尚未得到充分探究。通过文献综述以及我们近期对ESRD患者血管钙化的研究发现，高磷血症在非糖尿病ESRD患者中与血管钙化显著相关，而在糖尿病ESRD患者中可能并非血管钙化的显著危险因素。在糖尿病患者中，血管钙化在透析治疗开始前很久就已发生，非尿毒症糖尿病患者中与血管钙化相关的因素似乎是高血糖及相关代谢紊乱，如糖基化增加和氧化应激。在糖尿病ESRD患者中，高血糖也被认为是与血管钙化进展相关的重要因素。因此，分别在糖尿病和非糖尿病ESRD患者中强调控制血糖和磷对于预防血管钙化进展的重要性。
