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      A High Calcium-Phosphate Product Is Associated with High C-Reactive Protein Concentrations in Hemodialysis Patients

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          Abstract

          Background: An elevated Ca×PO<sub>4</sub> product and C-reactive protein (CRP) have been associated with coronary artery calcification and increased cardiovascular mortality in hemodialysis (HD) patients. However, it has not been defined, so far, whether and how both parameters are related to each other. For this reason we have evaluated in a cross-sectional and in an interventional study the possible correlation between Ca×PO<sub>4</sub> and CRP and the effect of the correction of a high Ca×PO<sub>4</sub> on CRP levels. Methods: 47 uremic patients (age 65 ± 16 years) on regular chronic HD were selected from a total population of 125 prevalent patients treated at our Institution. Patients had no clinical evidence of either acute infectious or inflammatory diseases for at least 4 weeks before the study. They were on regular bicarbonate HD for 6–329 months (median 42). CRP, hemoglobin (Hb), serum albumin (sAlb), protein catabolic rate (PCRn), serum calcium (Ca), serum phosphorus (PO<sub>4</sub>), Ca×PO<sub>4</sub>, intact PTH, Kt/V, presence of ischemic heart disease (IHD) and/or peripheral vascular disease (PVD) were recorded. CRP was Ln-transformed in all statistical analyses because of positive skewness. Results: The main findings were: LnCRP 2.17 ± 0.77 mg/l, Ca 10.1 ± 0.4 mg/dl, PO<sub>4</sub> 5.8 ± 0.6 mg/dl, Ca×PO<sub>4</sub> 59 ± 6 mg<sup>2</sup>/dl<sup>2</sup>, andPTHint 218 ± 195 ng/ml. 18/47 had IHD, 18/47 PVD. A significant hyperbolic correlation between Ca×PO<sub>4</sub> and CRP was observed. A piecewise linear regression model analysis identified a break-point for Ca×PO<sub>4</sub> at 55 mg<sup>2</sup>/dl<sup>2</sup>. Comparison of CRP levels after the division of the patients into two groups according to Ca×PO<sub>4</sub> break-point (group A, Ca×PO<sub>4</sub> ≤55 mg<sup>2</sup>/dl<sup>2</sup>, n = 16 patients; group B, Ca×PO<sub>4</sub> >55 mg<sup>2</sup>/dl<sup>2</sup>, n = 31 patients) showed that CRP levels were significantly lower in patients in group A (LnCRP 1.43 ± 0.22 mg/l) than in group B (LnCRP 2.55 ± 0.67 mg/l, p < 0.0001). Multiple regression analysis bearing LnCRP as dependent variable confirmed Ca×PO<sub>4</sub> as the most significant variable among the other variables examined. In 22 patients with Ca×PO<sub>4</sub> ≧60 mg<sup>2</sup>/dl<sup>2</sup>, we performed intensive lowering of the Ca×PO<sub>4</sub> product in order to reach and maintain a Ca×PO<sub>4</sub> ≤55 mg<sup>2</sup>/dl<sup>2</sup> for 3 months. At the end of observation, a significant reduction in Ca×PO<sub>4</sub> and LnCRP was observed (Ca×PO<sub>4</sub> pre 62.8 ± 1.9 vs. post 46.3 ± 6.2 mg<sup>2</sup>/dl<sup>2</sup>: p < 0.0001; LnCRP pre 2.32 ± 0.36 vs. post 1.83 ± 0.14 mg/l: p < 0.0001). No significant variation in the other biochemical parameters was observed. Conclusions: Our data show that in chronic HD patients in steady clinical conditions with no clinical evidence of either infectious or inflammatory diseases, a high Ca×PO<sub>4</sub> is associated with high CRP concentrations. Intensive lowering of Ca×PO<sub>4</sub> reduces CRP.

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          Author and article information

          Journal
          NEC
          Nephron Clin Pract
          10.1159/issn.1660-2110
          Nephron Clinical Practice
          S. Karger AG
          1660-2110
          2005
          December 2005
          10 August 2005
          : 101
          : 4
          : c161-c167
          Affiliations
          aChair and Division of Nephrology, Spedali Civili and University of Brescia, and bSection of Medical Statistics, Department of Biosciences, University of Brescia, Brescia, Italy
          Article
          87391 Nephron Clin Pract 2005;101:c161–c167
          10.1159/000087391
          16103720
          83a8c097-0ee5-4750-b768-8fed20fa81fd
          © 2005 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          History
          : 17 September 2004
          : 17 February 2005
          Page count
          Figures: 2, Tables: 6, References: 25, Pages: 1
          Categories
          Editorial Review

          Cardiovascular Medicine,Nephrology
          Cardiovascular Medicine, Nephrology

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