Department of Nephrourology, Great Ormond Street Hospital for Children, NHS Trust, Great Ormond Street, London, WC1N 3JH, United Kingdom.
Pediatr Nephrol. 2011 Jun;26(6):853-65. doi: 10.1007/s00467-010-1691-y. Epub 2010 Nov 16.
Since the inception of pediatric dialysis programmes nearly 50 years ago, there have been vast improvements in both the technology and expertise in the care of children with chronic kidney disease (CKD). Nevertheless, children on dialysis continue to have a significantly higher mortality than their healthy peers and cardiovascular disease (CVD) is the most common cause of death in this group. Chronic kidney disease is described as the "perfect storm" of risk factors for CVD development, and vascular calcification is a highly regulated cell-mediated process with several promoters and inhibitors of calcification. CVD begins early in the course of CKD and there is an independent and graded association between cardiovascular morbidity and renal decline. Also, it is shown that once vascular damage and calcification begin, they progress inexorably in the uraemic milieu and may only be partially reversed after successful transplantation. Thus, preventing the development of CVD is key, and early identification and management of specific CVD-related risk factors should begin from the early stages of CKD. While the vasculopathy of childhood CKD is clearly multifactorial, clinical, epidemiological and cell biology studies provide converging evidence pointing to the role of dysregulated mineral metabolism as an important modifiable risk factor in the development of vascular calcification. In this review we focus on the role of calcium, phosphate, parathyroid hormone and vitamin D in ectopic vascular calcification, and discuss the role of screening, early intervention and management of established vascular calcification.
自近 50 年前儿科透析项目成立以来，儿童慢性肾脏病（CKD）治疗的技术和专业知识都取得了巨大的进步。尽管如此，接受透析治疗的儿童的死亡率仍明显高于健康同龄人，心血管疾病（CVD）是该人群死亡的最常见原因。慢性肾脏病被描述为 CVD 发展的“完美风暴”，血管钙化是一个高度受调节的细胞介导过程，有几个促进和抑制钙化的因素。CVD 在 CKD 病程早期就开始发生，心血管发病率与肾功能下降之间存在独立的、分级的关联。此外，研究表明，一旦血管损伤和钙化开始，它们就在尿毒症环境中无情地进展，并且在成功移植后可能只能部分逆转。因此，预防 CVD 的发生是关键，应从 CKD 的早期开始识别和管理特定的 CVD 相关风险因素。虽然儿童 CKD 的血管病变显然是多因素的，但临床、流行病学和细胞生物学研究提供的证据表明，矿物质代谢失调是血管钙化发生的一个重要可调节风险因素。在这篇综述中，我们重点关注钙、磷、甲状旁腺激素和维生素 D 在异位血管钙化中的作用，并讨论了血管钙化的筛查、早期干预和治疗。
