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PubMed2005

[Comparison of imaging methods for diagnosis of renal tumors and their calcifications].

BACKGROUND: To establish the best methodology for diagnosis and management of patients with solid and complex renal masses by comparing the costs and benefits of different imaging methods and to improve differential diagnosis of these benign and malignant lesions, particularly by investigating tumour calcifications. METHODS: We performed a prospective study on 31 patients with solid or complex masses by submitting them to Abdominal Ultrasonography (US), Doppler Ultrasonography of the renal mass (US Dop), Computed Tomography (CT), and Magnetic Resonance Imaging (MRI). RESULTS: We found 28 patients with malignant and three with benign masses. Of the 28 malignant, 17 showed calcifications at CT; 16 central and one was of the pure peripheral curvilinear type (egg shell). Excretory Urography (IVP) had a significantly lower detection rate for central calcifications than both US and CT. Benign and malignant masses appeared as described in literature, with US, CT and MRI showing high sensitivity and specificity in renal tumor diagnosis. The exception was US Dop where we obtained lower sensitivity for the characterization of malignant tumor flow. CONCLUSIONS: In this series we were surprised to find that CT revealed central calcifications in 51.6% of patients, all with malignant lesions, while, literature reports a frequency of calcification in renal cell carcinoma between 8 and 22%, in studies using abdominal films and EU (IVP). This finding is of great importance when we consider that these calcifications occur particularly in malignant neoplasms. As a result of comparing these different imaging methods we have developed a better methodology for renal tumor investigation.

Adult↗
PubMed2004

Uremia accelerates both atherosclerosis and arterial calcification in apolipoprotein E knockout mice.

Chronic renal failure (CRF) favors the development of atherosclerosis and excessive calcification of atheromatous lesions. CRF was induced in apolipoprotein E knockout (apoE(-/-)) mice to study (1) a possible acceleration of aortic atherosclerosis, (2) the degree and type of vascular calcification, and (3) factors involved in the calcification process. For creating CRF, 8-wk-old apolipoprotein E gene knockout (apoE(-/-)) mice underwent partial kidney ablation. Control animals underwent sham operation. Aortic atherosclerotic plaques and calcification were evaluated using quantitative morphologic image processing. At 6 wk after nephrectomy, CRF mice had significantly higher serum urea, cholesterol, and triglyceride concentrations than non-CRF controls. The serum levels of advanced oxidation protein products were elevated in the uremic group and were correlated with serum urea levels. Atherosclerotic lesions in thoracic aorta were significantly larger in uremic apoE(-/-) mice than in nonuremic controls. The relative proportion of calcified area to total surface area of both atherosclerotic lesions and lesion-free vascular tissue was increased in aortic root of uremic apoE(-/-) mice when compared with controls. The calcium deposits were made of hydroxyapatite and calcite crystals. In addition, plaques from uremic animals showed a significant increase in collagen content, whereas the degree of macrophage infiltration was comparable in both groups. There was no difference in mean arterial BP. These findings demonstrate that CRF aggravates atherosclerosis in apoE(-/-) mice. Moreover, CRF enhances arterial calcification at both atheromatous intimal sites and atheroma-free medial sites. We anticipate that this experimental model will be useful to test treatment strategies aimed at decreasing the accelerated atherosclerosis and arterial calcification in uremia.

Animals↗
PubMed2006

Calcimimetic R-568 decreases extraosseous calcifications in uremic rats treated with calcitriol.

Calcimimetics decrease parathyroid hormone (PTH) levels in uremic patients with secondary hyperparathyroidism without increasing serum calcium (Ca). The aim of this study was to evaluate the effect of calcimimetic R-568 alone or in combination with calcitriol on vascular and other soft tissue calcifications in uremic rats with secondary hyperparathyroidism. Sham-operated and 5/6 nephrectomized Wistar rats were studied. 5/6 Nephrectomized rats were treated with vehicle, calcitriol (80 ng/kg every other day), R-568 (1.5 and 3 mg/kg per d), and both calcitriol and R-568 1.5 mg/kg, as above. Rats were killed after 14 or 56 d of treatment. Blood was drawn for biochemical measurements. Aortic, heart, kidney, lung, and stomach tissue samples were processed for histopathology and measurement of tissue Ca and phosphorus content. PTH concentrations were significantly reduced by all treatments. Treatment with calcitriol induced significant vascular calcification (aortic Ca increased to 4.2+/-1.2 mg/g at day 14 and to 11.4+/-0.7 mg/g at day 56; P<0.05 versus vehicle). Treatment with R-568 did not induce vascular calcification. Concurrent administration of R-568 with calcitriol reduced the aortic Ca (1.9+/-0.2 mg/g at day 14 and 7.5+/-1.4 mg/g at day 56) in relation to calcitriol alone. Soft tissue calcifications mirrored aortic mineralizations. Survival was significantly (P<0.001) reduced in calcitriol-treated rats, and mortality was attenuated (P=0.01) by concurrent treatment with R-568. In uremic rats, R-568 reduces elevated PTH levels without inducing vascular calcification, prevents calcitriol-induced vascular calcification, and decreases mortality.

Aniline Compounds↗
PubMed2005

Vitamin K in the treatment and prevention of osteoporosis and arterial calcification.

PURPOSE: The role of vitamin K in the prevention and treatment of osteoporosis and arterial calcification is examined. SUMMARY: Vitamin K is essential for the activation of vitamin K-dependent proteins, which are involved not only in blood coagulation but in bone metabolism and the inhibition of arterial calcification. In humans, vitamin K is primarily a cofactor in the enzymatic reaction that converts glutamate residues into gamma-carboxyglutamate residues in vitamin K-dependent proteins. Numerous studies have demonstrated the importance of vitamin K in bone health. The results of recent studies have suggested that concurrent use of menaquinone and vitamin D may substantially reduce bone loss. Menaquinone was also found to have a synergistic effect when administered with hormone therapy. Several epidemiologic and intervention studies have found that vitamin K deficiency causes reductions in bone mineral density and increases the risk of fractures. Arterial calcification is an active, cell-controlled process that shares many similarities with bone metabolism. Concurrent arterial calcification and osteoporosis have been called the "calcification paradox" and occur frequently in postmenopausal women. The results of two dose-response studies have indicated that the amount of vitamin K needed for optimal gamma-carboxylation of osteocalcin is significantly higher than what is provided through diet alone and that current dosage recommendations should be increased to optimize bone mineralization. Few adverse effects have been reported from oral vitamin K. CONCLUSION: Phytonadione and menaquinone may be effective for the prevention and treatment of osteoporosis and arterial calcification.

Antifibrinolytic Agents↗
PubMed2005

Vascular calcifications in chronic kidney disease: are there new treatments?

Cardiovascular disease is extremely common in patients with end-stage renal disease (ESRD) and accounts for at least 50% of deaths among these patients. Vascular calcifications (VC) have been recently implicated as a possible cause of this excess cardiovascular mortality. Medial calcification is a striking feature of vascular disease in patients with ESRD. The traditional view that VC is a degenerative and passive process has been seriously challenged, based on strong evidence suggesting that VC is an active and highly regulated process similar to bone formation. Different data support the notion that elevated levels of phosphorus and/or other uremic toxins may play an important role by transforming vascular smooth muscle cells into osteoblast-like cells, which can produce bone matrix proteins. This nidus can then mineralize if the balance of pro-mineralizing factors outweighs inhibitory factors. The advent of newer noninvasive screening tests have generated great interest for screening patients with ESRD for vascular calcifications. Control of serum phosphorus with sevelamer, a recently developed non-calcium, non-aluminum phosphate binder, have attenuated or arrested progression of coronary artery and aortic calcifications compared to treatment with calcium-based binders. Amino bisphosphonates, have shown to completely inhibit soft tissue calcifications, calciphylaxis and prevent death in animal models. The first generation bisphosphonate, etidronate, reduces the progression of coronary artery calcifications patients receiving long-term hemodialysis and intravenous pamidronate has produced a rapid improvement of calciphylaxis. In conclusion, VC is a widespread phenomenon in patients with ESRD with important cardiovascular consequences. A better understanding of the processes of VC is leading to therapies to retard or improve this phenomenon and will probably have an important impact on patient mortality.

Animals↗
PubMed1980

Two-dimensional echocardiography in mitral annulus calcification.

Mitral annular calcification, established by fluoroscopy, was studied by M-mode and two-dimensional echocardiography in 18 patients. M-mode echocardiography revealed the typical dense, linear echo of mitral annular calcification, but not its extent. Two-dimenstional echocardiography demonstrated a dense, elipsoidal echo at the junction of the left atrium and ventricle in the long axis view, and an area of calcification below the mitral valve in the short axis view. These patterns were not seen in 20 control patients without mitral annular calcification by fluoroscopy. Two-dimensional echocardiography establishes the site and extent of mitral annular calcification, minimizes the potential for diagnostic error associated with M-mode echocardiography, and is superior to M-mode echocardiography for the recognition of mitral annular calcification.

Aged↗
PubMed1987

Breast calcifications in renal hyperparathyroidism.

A prospective mammographic study was performed on 151 women to determine the prevalence of breast calcifications in patients with chronic renal failure. Frequency, size, structure, and location of calcific lesions were assessed in 15 patients with compensated renal insufficiency, 22 on hemodialysis, 14 who had renal transplants, and 100 who had normal kidney function. Serum levels of calcium, phosphorus, alkaline phosphatase, and parathyroid hormone were determined for all 151 women. The calcific lesions occurred preponderantly in dialysis patients (arteries, 55%; parenchyma, 68%; and ducts, 36%). Next in order were those with renal transplants (43%, 64%, and 29%, respectively) and those with renal insufficiency (33%, 53%, and 20%, respectively). Patients with renal disease had significantly more calcifications (p less than .001) than the patients with normal kidney function: arteries, 45% vs 8%; parenchyma, 61% vs 27%; and ducts, 29% vs 9%. Frequencies of calcifications correlated with serum levels of parathyroid hormone. None of the calcifications induced by renal disease simulated those seen in carcinoma of the breast.

Adult↗
PubMed2006

Usefulness of cardiac calcification on two-dimensional echocardiography for distinguishing ischaemic from nonischaemic dilated cardiomyopathy: a preliminary report.

BACKGROUND: Aortic valve calcification (AVC) and/or mitral annulus calcification (MAC) is considered to be a marker of atherosclerosis and has been demonstrated to predict cardiovascular morbidity and mortality. AIM: We hypothesized that the presence of cardiac calcification by echocardiography can be used in the differential diagnosis between ischaemic (DCMI+) and nonischaemic dilated cardiomyopathy (DCMI-). METHODS: We evaluated 62 patients with DCM (38 males, mean age 66 +/- 10 years, LVEF < 40%), without any prior history of myocardial infarction or coronary intervention, who were undergoing coronary angiography for aetiological diagnosis. DCMI+ was considered present when a > or = 70% stenosis of at least one coronary artery was found. AVC, MAC, aortic wall and papillary muscle calcifications were semiquantitatively assessed by two-dimensional echocardiographic examination with a calcium score ranging from 0 (no calcifications) to 8 (calcium in all four sites). RESULTS: DCMI+ was found in 20 out of 62 patients. As expected, there were no differences in LVEF and LV end-diastolic diameters between DCMI+ and DCMI--patients (29 +/- 8% versus 31 +/- 10% and 66 +/- 6 versus 68 +/- 8 mm, respectively; not significant). Regional wall motion abnormalities and conventional risk factors for atherosclerosis, such as hypertension and hypercholesterolaemia, were significantly more frequent in the DCMI+ compared to the DCMI- group. On the other hand, the calcium echo score was 4.6 +/- 2 (range 1.7-7.3) in DCMI+ patients and 0.8 +/- 0.95 (range 0-4) in DCMI--patients (P < 0.05). A calcium score > or = 3 was observed in 18 out of 20 (90%) DCMI+ patients and only in three of 42 (8%) DCMI--patients. CONCLUSIONS: The assessment of cardiac calcification by two-dimensional echocardiography could represent a simple, noninvasive and inexpensive approach to assess the aetiology (ischaemic versus nonischaemic) of dilated cardiomyopathy.

Adult↗
PubMedDate not supplied

Stereotactic core-needle biopsy of non-mass calcifications: outcome and accuracy at long-term follow-up.

OBJECTIVE: To determine, by means of long-term follow-up evaluation, the outcome and accuracy of stereotactic core-needle biopsy (SCNB) of non-mass calcifications observed at mammography, and to analyze the factors contributing to false-negative findings. MATERIALS AND METHODS: Using a 14-gauge needle, SCNB was performed in cases involving 271 non-mass calcified lesions observed at mammography in 267 patients aged 23 72 (mean, 47) years. We compared the SCNB results with those of long-term follow-up which included surgery, mammography performed for at least six months, and reference to Korean Cancer Registry listings. We investigated the retrieval rate for calcifications observed at specimen mammography and histologic evaluation, and determined the incidence rate of cancer, sensitivity, and the underestimation rate for SCNB. False-negative cases were evaluated in terms of their mammographic findings, the effect of the operators' experience, and the retrieval rate for calcifications. RESULTS: For specimen mammography and histologic evaluation of SCNB, the retrieval rate for calcifications was, respectively, 84% and 77%. At SCNB, 54 of 271 lesions (19.9%) were malignant [carcinoma in situ, 45/54 (83%)], 16 were borderline, and 201 were benign. SCNB showed that the incidence of cancer was 5.0% (6/120) in the benign mammographic category and 31.8% (48/151) in the malignant category. The findings revealed by immediate surgery and by longterm follow-up showed, respectively, that the sensitivity of SCNB was 90% and 82%. For borderline lesions, the underestimation rate was 10%. For false-negative cases, which were more frequent among the first ten cases we studied (p = 0.01), the most frequent mammographic finding was clustered amorphous calcifications. For true-negative and false-negative cases, the retrieval rate for calcifications was similar at specimen mammography (83% and 67%, respectively; p = 0.14) and histologic evaluation (79% and 75%, respectively; p = 0.47). CONCLUSION: In this study group, most diagnosed cancers were in-situ lesions, and long-term follow-up showed that the sensitivity of SCNB was 82%. False-negative findings were frequent during the operators' learning period.

Adult↗
PubMed2005

Descriptive study of chronic calcific pancreatitis in Sri Lanka.

OBJECTIVES: To describe the potential risk factors, clinical features, biochemical and radiological features, and management of chronic calcific pancreatitis. DESIGN: Cross-sectional descriptive study. SETTING: Tertiary care general hospital. PATIENTS: Fifty patients with pancreatic calcification referred to the Colombo South Teaching Hospital, and 50 age-matched controls from healthy relatives or friends of the patients. MEASUREMENT: Height and weight measurements, immunoreactive insulin levels and trypsin levels of duodenal aspirates were estimated. Plain abdominal xray and ultrasonography were performed. INTERVENTION: Endoscopic retrograde cholangiopancreaticography (ERCP) was attempted on all patients during which duodenal aspirates were collected. Success rates of ERCP and response to endotherapeutic procedures were recorded. RESULTS: Twenty two of the 50 chronic calcific pancreatitis (CP) patients were diagnosed to have chronic alcoholic calcific pancreatitis (CACP). Mean age of the CACP patients was significantly higher than that of the chronic calcific pancreatitis of the tropics (CCPT) patients. Severe malnutrition (BMI < 20), frequent consumption of Manihot esculenta (manioc, cassava) and a high consumption of chilli or pepper were identified as possible risk factors for both alcoholic and non-alcoholic CP. Onset of diabetes occurred at a much younger age in the CCPT group than in the CACP group. Mean serum insulin was significantly higher in the CCPT group than in the CACP group and duodenal trypsin level was significantly lower in the CCPT than in CACP group. CONCLUSIONS: Our results confirm the existence of both alcoholic (CACP) and non-alcoholic (CCPT) types of chronic calcific pancreatitis in Sri Lanka. A larger study is required to confirm the associated risk factors such as Manihot esculenta and foods with a high content of chilli or pepper.

Adult↗
PubMed2006

Coronary artery calcification revisited.

Calcification is a common finding in human coronary arteries. However, there is conflicting evidence for a link between calcification and plaque instability. Current intravascular ultrasound (IVUS) technology allows a definitive detection of the calcification and measurement of the vessel wall. Using preinterventional IVUS images, we clarified that in patients with acute myocardial infarction, small "spotty" calcifications prevailed, associated with a fibrofatty plaque and positive remodeling. Conversely, in patients with stable angina pectoris, extensive calcification was frequent. IVUS allows the detection of vulnerable plaques in coronary arteries, by identifying not only a large lipid core and positive remodeling, but also a spotty pattern of calcification.

Calcinosis↗
PubMed2002

Accelerated calcification represses the expression of elastic fiber components and lysyl oxidase in cultured bovine aortic smooth muscle cells.

Vascular calcification is a common feature of advanced atherosclerosis resulting in reduced elasticity of elastic arteries. However, the relationship between elastic fibers and vascular calcification at the molecular and cellular levels remains unknown. We investigated the expression of major elastic fiber components such as tropoelastin (TE) and fibrillin-1 (FBN1) and elastin-related enzyme, lysyl oxidase (LO), in a calcification model using beta-glycerophosphate (beta-GP) in cultured bovine aortic smooth muscle cells (BASMCs). Ten mM of beta-GP stimulated calcium deposition in a time-dependent manner. As determined by Western blot analysis, 10 mM of beta-GP time-dependently decreased TE and FBN1 protein levels. TE, FBN1, and LO mRNA levels, assessed by reverse transcription-polymerase chain reaction, were also decreased by exposure to 10 mM beta-GP. Furthermore, we investigated whether the processes of calcification in BASMCs directly control these regulations. In experiments using levamisole, an alkaline phosphatase inhibitor, and DMDP, a bisphosphonate, both inhibitors inhibited down-regulation during beta-GP-induced calcification, suggesting that the down-regulation of TE, FBN1, and LO directly relates to calcium deposition. In cases of vascular calcification, the decreased expression of TE, FBN1, and LO may be partially responsible for decreased vascular elasticity and also for the decreased formation of new elastic fibers.

Alkaline Phosphatase↗
PubMed2000

Calcific constrictive pericarditis: is it still with us?

BACKGROUND: The presence of pericardial calcification on a plain radiograph strongly suggests constrictive pericarditis in patients with heart failure. However, calcific constrictive pericarditis is considered rare in the United States since tuberculosis incidence has decreased, and doubt has therefore been raised about the importance of this radiologic finding in modern cardiovascular practice. OBJECTIVE: To determine the clinical and prognostic significance of pericardial calcification on radiography in patients with constrictive pericarditis. DESIGN: Retrospective cohort study. SETTING: Tertiary referral center. PATIENTS: A consecutive series of 135 patients (mean age +/- SD, 56 +/- 16 years) who from 1985 through 1995 had constrictive pericarditis confirmed surgically (n = 133) or by autopsy (n = 2). Patients were divided into two groups: those with pericardial calcification on chest radiography (group I) and those without (group II). MEASUREMENTS: Clinical and diagnostic findings were compared in both groups, and outcome was compared in 132 patients who had pericardiectomy. RESULTS: Pericardial calcification was seen in 36 patients (27%). The cause of constrictive pericardial disease was indeterminate in 67% of patients in group I and in 21% of patients in group II (P < 0.001). Patients in group I had had symptoms for a longer period and were more likely to have pericardial knock, larger atrial size, and atrial arrhythmia. Significantly more perioperative deaths were seen in group I, but incidence of late survival and incidence of noncalcific disease were similar in both groups. CONCLUSIONS: Pericardial calcification is a common finding in patients with constrictive pericarditis. It is often associated with idiopathic disease and other markers of disease chronicity and is an independent predictor of increased perioperative mortality rates.

Adolescent↗
PubMed1975

Pulmonary calcification in chronic dialysis patients. Clinical and pathologic studies.

A prospective study of 31 chronically hemodialyzed patients was made to investigate the incidence and pathology of pulmonary calcification and the relation of the latter to ventilatory function. Fifteen of the patients have died thus far; 9 had evidence of lung calcification. The lesions occurred predominately in alveolar septa and were associated with varying degrees of fibrosis and alveolar septal thickening. Only one patient had X-ray evidence of calcification. An X-ray diffraction analysis showed a predominant pattern of whitlockite (CaMg)3(Po4)2 in deposits. Patients with the severest pulmonary calcification had abnormalities of vital capacity, carbon monoxide diffusion, and Po2. Serum calcium levels were slightly higher in patients with calcification, but there was no measurable association with the duration of dialysis, serum phosphorus, calcium X phosphorus product, magnesium, bicarbonate, or arterial pH. These data show that pulmonary calcification occurs with high frequency in patients undergoing long-term hemodialysis and that such lesions are associated with restrictive and diffusion ventilatory defects.

Adult↗
PubMed2001

High detection rate of breast ductal carcinoma in situ calcifications on mammographically directed high-resolution sonography.

OBJECTIVE: To assess the high-frequency sonographic characteristics of ductal carcinoma in situ of the breast. METHODS: In a retrospective review, we identified 18 patients with biopsy-proven pure ductal carcinoma in situ who had received mammographic and high-frequency sonographic examinations at transducer frequencies of 8-15 MHz, 8-5 MHz and 5 to 13 MHz [corrected]. RESULTS: All 18 patients had mammographically identified calcifications. Four (22%) of the 18 had either asymmetric focal mammographically identified densities or masses with the calcifications. These calcifications were identified sonographically in 17 (94%) of the 18 patients. In 9 (50%) of 18 patients, the calcifications were associated with sonographically detected malignant masses, and in 3 (17%) of 18 patients the calcifications were within focally dilated ducts. Lesions that had masses or dilated ducts visible on sonography represented 9 (82%) of 11 of the grade 3 neoplasms and only 2 (28%) of 7 of the grade 1 and 2 tumors. This difference was statistically significant (P < .039). CONCLUSIONS: Our study showed that ductal carcinoma in situ may appear on sonography as calcifications, masses, or focally dilated ducts. Those lesions that were associated with masses or dilated ducts on sonography were more likely high-grade histologic specimens.

Breast Neoplasms↗
PubMed2000

Intracranial calcifications in childhood medulloblastoma: relation to nevoid basal cell carcinoma syndrome.

BACKGROUND AND PURPOSE: Medulloblastoma is one of the most common posterior fossa tumors to occur in children. Our purpose was to document the frequency, location, and time of occurrence of intracranial calcifications in cranial CT studies of children with medulloblastoma. METHODS: We retrospectively reviewed cranial CT studies of 56 patients diagnosed with medulloblastoma from 1983 through 1997 for the presence of intracranial calcifications. The findings were compared with 159 cranial CT studies of patients who were evaluated in the emergency department (control group). Thirty-two patients with medulloblastoma without shunts were compared with 118 patients from the control group without shunts. Similarly, 24 patients with medulloblastoma with shunts were compared with 41 patients from the control group with shunts. RESULTS: Overall, three (9%) patients with medulloblastoma without shunts, four (16%) patients with medulloblastoma with shunts, and four (10%) patients from the control group with shunts had falx calcification. Only the two children carrying the diagnoses of medulloblastoma and nevoid basal cell carcinoma syndrome, however, had calcification of the falx cerebri shown on the cranial CT scans obtained during the peridiagnostic period. Both were diagnosed with medulloblastoma before the age of 3 years and later developed jaw cysts and multiple basal cell carcinomas in the radiation field. CONCLUSION: Previous studies have shown that falx calcification is a major component of nevoid basal cell carcinoma syndrome. Our two cases illustrate the importance of considering the diagnosis of nevoid basal cell carcinoma syndrome when falx calcification is present in young patients with medulloblastoma. If the concomitant diagnosis of nevoid basal cell carcinoma syndrome is made, alternative types of therapy should be sought to minimize radiation therapy sequelae.

Adolescent↗
PubMed1975

Idiopathic arterial calcification of infancy: a clinicopathologic study.

The clinical and pathologic features of a group of 62 infants dying of idiopathic calcific arterial disease were reviewed. The disease most commonly occurs in infants less than 6 months of age. Pathologically, it is characterized by calcific deposits along the internal elastic membrane of arteries accompanied by fibrous thickening of the intima which causes luminal narrowing. The arterial lesions are widespread but the resultant luminal narrowing invariably promotes myocardial ischemia, causing the infants' deaths. A definite tendency of the disease to occur in siblings has been noted, but additional patterns of inheritance are not yet apparent. Clinical diagnosis is feasible with radiologic study of arteries of the head, neck, and extremities. There is a similarity of idiopathic calcific arterial disease of infancy to the arterial lesions of metastatic calcification in severe renal disease, calcific arterial lesions noted in conjunction with certain cardiovascular anomalies, and hypervitaminosis D. Certain experimental situations and toxic states can also produce calcific and proliferative vascular lesions.

Arterial Occlusive Diseases↗
PubMed2000

Detection and quantification of cardiovascular calcifications with electron beam tomography to estimate risk in hemodialysis patients.

Cardiovascular disease is the leading cause of death in dialysis patients, accounting for nearly half of all deaths among end-stage renal disease (ESRD) patients. Even young dialysis patients are at risk. Cardiovascular disease in chronic renal failure patients has been associated with elevated serum phosphorus levels and elevated calcium-phosphorus (Ca x P) product, and mismanagement of calcium and phosphorus metabolism has been implicated as a major factor in the development of soft tissue calcification and cardiovascular disease. ESRD patients frequently face hyperphosphatemia as well as excess calcium load, which elevate the Ca x P product, thereby contributing to the development of calcific complications. Electron beam computed tomography (EBCT) can be used to detect different calcification stages in a variety of tissues, and is a sensitive tool for detecting calcified coronary artery plaques as well as cardiac and valvular calcifications. Hemodialysis patients have high calcium scores on EBCT imaging, and these are associated with elevations in Ca x P product. In a recent study, patients with calcification were found to have had twice the daily calcium intake from calcium-based phosphate binders than patients without calcification. Strategies to reduce cardiac risk in hemodialysis patients include use of a dialysate low in calcium, use of vitamin D analogs that are less calcemic, and use of calcium-free phosphate binders. EBCT can be a useful adjunct to these therapies, since it permits sensitive and quantitative initial assessment, as well as ongoing monitoring of disease progression.

Calcinosis↗