Detection and quantification of cardiovascular calcifications with electron beam tomography to estimate risk in hemodialysis patients

Cardiovascular disease is the leading cause of death in dialysis patients, accounting for nearly half of all deaths among end-stage renal disease (ESR D) patients. Even young dialysis patients are at risk. Cardiovascular disea se in chronic renal failure patients has been associated with elevated seru m phosphorus levels and elevated calcium-phosphorus (Ca x P) product, and m ismanagement of calcium and phosphorus metabolism has been implicated as a major factor in the development of soft tissue calcification and cardiovasc ular disease. ESRD patients frequently face hyperphosphatemia as well as ex cess calcium load, which elevate the Ca x P product, thereby contributing t o the development of calcific complications. Electron beam computed tomogra phy (EBCT) can be used to detect different calcification stages in a variet y of tissues, and is a sensitive tool for detecting calcified coronary arte ry plaques as well as cardiac and valvular calcifications. Hemodialysis pat ients have high calcium scores on EBCT imaging, and these are associated wi th elevations in Ca x P product. In a recent study, patients with calcifica tion were found to have had twice the daily calcium intake from calcium-bas ed phosphate binders than patients without calcification. Strategies to red uce cardiac risk in hemodialysis patients include use of a dialysate low in calcium, use of vitamin D analogs that are less calcemic, and use of calci um-free phosphate binders. EBCT can be a useful adjunct to these therapies, since it permits sensitive and quantitative initial assessment, as well as ongoing monitoring of disease progression.