Multidisciplinary Osteoporosis Program, Women's College Hospital, Toronto, Ontario, Canada.
Clin J Am Soc Nephrol. 2010 Jan;5 Suppl 1:S41-7. doi: 10.2215/CJN.05860809.
Cardiovascular disease (CVD) is the largest contributor to all-cause mortality in patients with end stage renal disease (ESRD). Accelerated vascular calcification is a key risk factor for CVD in these patients. The etiology of vascular calcification and the specific role calcium supplementation may play in accelerating calcification have not been fully elucidated.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We summarize published data that report on the association between calcium supplementation, vascular calcification, and CVD in patients with and without ESRD.
The majority of randomized, controlled trials in patients with ESRD suggest that calcium supplementation--in the form of calcium-based phosphate binders--leads to a progression of vascular calcification. However, studies showing that calcium-based phosphate binders increase cardiovascular mortality are lacking in patients with ESRD. In contrast, one randomized trial in healthy postmenopausal women reported that, compared with those not receiving calcium supplementation, women who take supplements are at an increased risk for cardiovascular events.
Given the potential for harm with calcium supplementation in healthy postmenopausal women and the evidence that calcium-based phosphate binders are associated with adverse intermediate outcomes in patients with ESRD, calcium-either as a phosphate binder or as a supplement--should be prescribed with caution.
心血管疾病（CVD）是终末期肾病（ESRD）患者全因死亡率的最大贡献者。血管钙化加速是这些患者 CVD 的关键风险因素。血管钙化的病因以及钙补充剂在加速钙化中可能发挥的具体作用尚未完全阐明。
设计、设置、参与者和测量：我们总结了已发表的报告 ESRD 患者中钙补充剂、血管钙化和 CVD 之间关系的数据。
大多数 ESRD 患者的随机对照试验表明，钙补充剂（以钙基磷酸盐结合剂的形式）可导致血管钙化进展。然而，在 ESRD 患者中，缺乏表明钙基磷酸盐结合剂会增加心血管死亡率的研究。相比之下，一项针对健康绝经后妇女的随机试验报告称，与未接受钙补充的妇女相比，服用补充剂的妇女发生心血管事件的风险增加。
鉴于钙补充剂在健康绝经后妇女中可能存在危害，并且钙基磷酸盐结合剂与 ESRD 患者不良中间结局相关，钙（无论是作为磷酸盐结合剂还是补充剂）的处方应谨慎。
