CKD矿物质和骨代谢紊乱及预后.pptVIP

* There are two types of vascular calcification that occur in distinct areas of the artery wall, the intima and the media. These can be differentiated by histology, consequence, occurrence, and the type of cells and factors associated with them.1 Arterial intimal calcification occurs in atherosclerotic plaques. It can result in acute occlusion when the plaque ruptures.1 It is mainly observed in older patients with a history of diabetes and atherosclerosis and atherosclerotic complications before starting hemodialysis. It is associated with the typical risk factors of atherosclerotic disease.2 Arterial medial calcification occurs independently of intimal calcification and atherosclerosis. It is a non-occlusive condition. Medial vascular calcification leads to increased stiffness of the arterial wall and disturbances in blood flow, which can be assessed by aortic pulse wave velocity measurements.2,3 Medial calcification is observed in young and middle-aged CKD patients without conventional atherosclerotic risk factors and is closely associated with duration of hemodialysis and calcium phosphate disorders.2 CKD patients frequently exhibit both types of calcification.4 References: Proudfoot D, Shanahan CM. Biology of calcification in vascular cells: intima versus media. Herz. 2001;26:245-251. London GM, Guérin AP, Marchais SJ, Métivier F, Pannier B, Adda H. Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality. Nephrol Dial Transplant. 2003;18:1731-1740. Raggi P, Bellasi A, Ferramosca F, Islam T, Muntner P, Block GA. Association of pulse wave velocity with vascular and valvular calcificiation in hemodialysis patients. Kidney Int. 2007;71:802-807. Giachelli CM. Vascular calcification mechanisms. J Am Soc Nephrol. 2004;15:2959-2964. Persy V, Postnov A, Neven E, et al. High-resolution x-ray microtomography is a sensitive method to detect vascular calcification in living rats with chronic renal failure. Arterioscler Thr