课件：年慢性肾脏病梅长林.ppt

* * * Key Point: Valvular calcification may also be present in patients with stage 5 CKD and is clearly visible on EBT scans. The top pair of electron beam computed tomography (EBT) scans represent images of an extensively calcified mitral valve (appears as a ring shape) in a dialysis patient. Patient parameters were unknown. The transverse view (left) represents one electron beam “slice,” whereas the footprint view (right) represents 40 “slices” stacked together. The calcified areas are represented in both colors (blue and yellow). The lower pair of images show extensive coronary artery calcification in a dialysis patient, indicating advanced disease. Calcium deposits make up most of the dry weight of atherosclerotic lesions. While vascular calcification was previously considered uncommon, it is now known to be present in as many as 80% of significant lesions and in at least 90% of patients with coronary artery disease. Previously thought to be a passive process, vascular calcification is increasingly recognized as an active, regulated process. It is now known to be a major risk factor for cardiovascular events and a major contributor to systolic hypertension, heart failure, plaque rupture, and stenosis. [Parhami, 1996, 90A] Parhami F, Bostrom K, Watson K, Demer LL. Role of molecular regulation in vascular calcification. J Atheroscler Thromb. 1996;3:90?94. * CT fistulogram showing calcification in AVF. * * * Phosphate Binders: Summary Phosphate binders play an important role in managing hyperphosphatemia, typically reducing serum phosphorus by 2 mg/dL. This slide summarizes the advantages and disadvantages of the different types of phosphate binders, but there remains no evidence that these agents differ in their impact on outcomes. Aluminum-containing phosphate binders are highly effective, but they accumulate in patients.1 High systemic aluminum levels cause anemia, and also impact bone matrix mineralization to cause osteomalacia. High levels in the central