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      Hypoparathyroidism Potentiates Cardiovascular Complications through Disturbed Calcium Metabolism: Possible Risk of Vitamin D 3 Analog Administration in Dialysis Patients with End-Stage Renal Disease

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          Background/Aim: Progressive cardiovascular calcification in dialysis patients with end-stage renal disease (ESRD) is a serious complication; however, the precise mechanism remains uncertain. We tested whether metabolic calcium abnormalities and hypoparathyroidism might have a correlation with cardiovascular complications in ESRD patients. Methods: A series of 48 ESRD patients with cardiovascular diseases and/or congestive heart failure, aged 36–82 (61 ± 12) years, 23 male and 25 female, were enrolled in this study. Serum total calcium (Ca, mmol/l), inorganic phosphate (mmol/l), and intact parathyroid hormone (iPTH, pg/ml) levels were determined in all cases. Results: Organic heart disease was confirmed in 28 patients (58.3%), including 15 with coronary artery disease: 8 with aortic aneurysm, 8 with stenotic valvular heart disease, 9 with excessive mitral annular calcification, 3 with dialysis cardiomyopathy, and 7 with obstructive arterial disease. Serum iPTH measurement revealed hypoparathyroidism (iPTH <60) in 20 of 48 (41.7%) and hyperthyroidism (iPTH ≧200) in 13 of 48 (27.1%) subjects. The 20 patients with low iPTH had a higher prevalence of valvular heart disease, a higher total Ca level corrected for serum albumin (2.70 ± 0.30 in low iPTH vs. 2.47 ± 0.30 in normal iPTH, 2.35 ± 0.20 in high iPTH, p = 0.003) and a higher tendency of vitamin D<sub>3</sub> analog use (65% in low iPTH vs. 33% in normal iPTH and 46% in high iPTH, p = 0.078). Moreover, corrected serum Ca exhibited a negative logarithmic correlation with serum iPTH: corrected Ca = –0.284× log (iPTH) + 3.021 (r = 0.637, p = 0.0001). Multiple logistic regression analysis revealed diabetes and hypoparathyroidism (iPTH <60) as risk factors for cardiovascular complications in ESRD. Conclusion: These results suggest that hypercalcemia and hypoparathyroidism in conjunction with vitamin D<sub>3</sub> use might play an important role in cardiovascular complications of chronic dialysis patients.

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          Most cited references 3

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          Intact parathyroid hormone overestimates the presence and severity of parathyroid-mediated osseous abnormalities in uremia

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            Rapidly progressing, massive mitral annular calcification. Occurrence in a patient with chronic renal failure.

            Calcification of the mitral annulus developed in a patient while undergoing dialysis. The rapid onset of events corresponded to the onset of end-stage renal failure and uncontrolled secondary hyperparathyroidism. Sequential echocardiograms verified the progression of calcification of the annulus as well as the valve. A new systolic and diastolic murmur and reduced valve orifice on two-dimensional echocardiography suggested acquired nonrheumatic mitral stenosis and insufficiency. We propose that metastatic calcium deposition rather than long-term hypertensive and degenerative effects was the predominant mechanism for massive calcification of the annulus and valve. It is suggested that M-mode echocardiography be used sequentially to follow both the occurrence and progression of calcification of the mitral annulus or valve in patients with chronic renal failure, secondary hyperparathyroidism, or both.
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              Calcium metabolism and osteodystrophy after renal transplantation

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                Author and article information

                S. Karger AG
                January 2000
                19 January 2000
                : 84
                : 1
                : 13-20
                2nd Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
                45533 Nephron 2000;84:13–20
                © 2000 S. Karger AG, Basel

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                Figures: 4, Tables: 2, References: 28, Pages: 8
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