Different forms of cardiovascular disease seen in patients with CKD
Are there other forms of cardiovascular disease seen in patients with CKD?
Cardiovascular calcification is a frequent contributor to cardiovascular disease in CKD; it can occur either in heart valves, the tunica intima, or the tunica media of the blood vessels.
Calcified blood vessels can often be seen on plain x-rays in patients with CKD, particularly among the elderly or those being treated with dialysis. Though not fully understood, during vascular calcification, the smooth muscle cells of vessels express osteocytic phenotypes and the calcium phosphate deposition resembles hydroxyapatite seen in bone.
The greater the severity of vascular calcification, the greater the risk of death. There are many reasons why patients with CKD develop vascular calcification; an increase in serum phosphorus is considered to be an important contributor, and this may be a potentially modifiable risk factor.
Hence, the management of elevated phosphorus levels may reduce the risk for heart disease; however, this approach remains unproven.
Calciphylaxis, or cacificic uremic arteriolopathy, is an accelerated form of vascular calcification typically seen in patients with CKD stage 5. Risk factors include warfarin therapy, altered mineral metabolism, and obesity.
The process can lead to nonhealing wounds and is often fatal. Parathyroidectomy and/or sodium thiosulfate therapy may be of benefit.
