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To what extent can coronary calcification and arterial stiffness be influenced by the nephrologist?

In welchem Ausmaß kann eine Arterienversteifung und die Verkalkung der Koronararterien durch den Nephrologen beeinflusst werden?

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Clinical Research in Cardiology Supplements Aims and scope

Zusammenfassung

Eine Versteifung der Arterien und Kalkablagerungen der Koronararterien sind regelmäßig zu beobachtende Komplikationen bei Nierenpatienten. Sie treten verstärkt bei Dialysepatienten im Endstadium einer Nierenerkrankung auf. Diese Krankheitsmerkmale bestimmen im Wesentlichen die Morbidität und die Mortalität bei Nierenpatienten. Bei der Versteifung der Arterien im Rahmen einer Nierenerkrankung spielt die Kalzifikation der Gefäße eine entscheidende Rolle. Daher ist die richtige Einstellung des Kalziumphosphat-Metabolismus eine wesentliche Aufgabe bei der Behandlung dieser Erkrankung. Phosphatbindende Medikamente und neue Vitamin-D-Analoga können die Kalziumlast des Dialysepatienten verringern und dadurch eine Besserung des Zustands erreichen. Die Versteifung der Arterien kann durch eine Volumenänderung, durch Entzündungen, durch arterielle Kalkbildungen und durch die angepasste Steuerung des Blutdrucks beeinflusst werden; einschließlich der Hemmung der Renin-Angiotensin-Aldosteron-Achse und einer adäquaten Dialyse. Eine Nierentransplantation verbessert die arterielle Elastizität und sollte daher bei Dialysepatienten – wenn möglich – durchgeführt werden.

Summary

Increased arterial stiffness and arterial/coronary calcifications are frequent, early and severe complications in renal patients, being more prominent in end-stage renal disease patients on dialysis. Both processes are major determinants of cardiovascular morbidity and mortality in renal patients. Arterial stiffness in kidney disease is a consequence of several factors, including calcification of the vessel wall. The threat of arterial calcification makes appropriate handling of the calcium-phosphate metabolism in renal patients mandatory. This is often a difficult task; noncalcium-containing phosphate binders and newer vitamin D analogues may reduce the calcium load in dialysis patients. Arterial stiffness can be influenced by reduction of volume overload, inflammation, arterial calcification, proper blood pressure control, including the inhibition of the renin-angiotensin-aldosterone axis, and adequate (modern) dialysis. Renal transplantation clearly improves arterial elasticity and should be attempted whenever possible in dialysis patients.

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Authors and Affiliations

  1. Dialysis and Renal Transplantation Center, Parhon University Hospital, Carol 1st Blvd Nr. 50, Iasi, 6600, Romania

    A. Covic MD, PhD & P. Gusbeth-Tatomir MD

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  1. A. Covic MD, PhD
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  2. P. Gusbeth-Tatomir MD
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Correspondence to A. Covic MD, PhD.

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Covic, A., Gusbeth-Tatomir, P. To what extent can coronary calcification and arterial stiffness be influenced by the nephrologist?. Clin Res Cardiol Suppl 2 (Suppl 1), S15–S21 (2007). https://doi.org/10.1007/s11789-006-0032-y

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