Department of Renal Medicine, Westmead Hospital, Westmead, NSW, Australia.
Curr Opin Nephrol Hypertens. 2011 Jul;20(4):369-75. doi: 10.1097/MNH.0b013e328347486a.
Concern that calcium use may increase cardiovascular risk was previously the domain of nephrologists. By contrast, calcium supplementation has been promoted within the general community as beneficial to the maintenance of bone mineral density, as an adjunct to osteoporosis therapies and as potentially useful for cardiovascular health.
Studies of patients with normal serum creatinine levels have reported that combined calcium and vitamin D supplementation reduced fracture risk, and osteoporosis trials have generally included calcium and vitamin D in placebo and active arms. However, an increased risk of myocardial infarction and other cardiovascular events has now been reported in secondary analysis of a fracture study of patients taking calcium or placebo, in subsequent meta-analysis of 15 similar studies, and most recently in re-analysis of the Women's Health Initiative calcium, vitamin D dataset. These reports have been criticized regarding event ascertainment, adjudication and the use of composite outcomes.
Patients with chronic kidney disease (CKD) have impaired renal calcium regulation, abnormal bone turnover and are predisposed to positive calcium balance. If these general population data are proven, they should heighten our unease regarding the use of calcium salts in all stages of CKD, and particularly for patients with prevalent vascular calcification, suspected adynamic bone and high bone turnover.
过去，人们对钙的使用可能会增加心血管风险的担忧主要集中在肾病学家的领域。相比之下，钙的补充已在普通人群中得到推广，被认为有益于维持骨密度，作为骨质疏松症治疗的辅助手段，并且可能对心血管健康有益。
对血清肌酐水平正常的患者的研究表明，联合使用钙和维生素 D 可降低骨折风险，而骨质疏松症试验通常在安慰剂和活性药物组中都包含钙和维生素 D。然而，在一项接受钙或安慰剂治疗的骨折患者的二次分析中、随后的 15 项类似研究的荟萃分析中，以及最近在妇女健康倡议的钙、维生素 D 数据集的重新分析中，都报告了心肌梗死和其他心血管事件风险增加的情况。这些报告在事件确定、裁决以及使用复合结局方面受到了批评。
慢性肾脏病（CKD）患者的钙调节受损，骨转换异常，且易发生正钙平衡。如果这些人群数据得到证实，它们应该会使我们对 CKD 各阶段使用钙盐的情况更加担忧，尤其是对于有血管钙化、疑似动力性骨病和高骨转换的患者。
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