Chronic renal failure: From bone disease to bone and vascular disease

The accelarated atherosclerosis occurring in patients with chronic renal failure (CRF) is a well-known complication since the beginnin of dialysis. The relationship between vascular lesions and phosphocalcic abnormalities is a more recent concept. The relationship between increase in phosphate x calcium product and cardiac valvular calcifications was demonstrated in 1980. The relationship between high serum phosphate levels and mortality was shown in 1998. The strong prevalence of coronary calcifications in CRF patients was shown in 1996. In 2000, the association between these calcifications and the oral dose of calcium was strongly suggested. Thereafter, the mechanism,of these calcifications appeared much more complex, involving hypercholesterolernia, inflammation, and other factors. The relationships between hype rparathyroi d is rn and mortality were shown during the years 2000. There is also an association between hypoparathyroidism and mortality in dialysis patients but not in CRF patients before the dialysis stage. Another new concept is the discovery of a relationship between vitamin D deficiency, very frequent is CRF patients, and mortality. Treatment with active 1,25(OH)D is associated with a better survival. There is also an new interest in treatment with the 25(OH)D form since the enzyme 1-alpha-hydroxylase, which is responsible for its transformation in active form, is present in Multiple organs. (c) 2008 Elsevier Masson SAS. All rights reserved.