Non-invasive assessments of cardiovascular disease in patients with renal failure

Vascular calcification is common in patients with chronic renal failure. an d it may contribute to the very high mortality rate from cardiovascular cau ses in the end-stage renal disease population. Vascular calcification in ch ronic renal failure can arise from the calcification of the intimal layer o f arteries as a result of atherosclerosis or from medial wall calcification due largely to alterations in mineral metabolism. Although several reports indicate that coronary artery calcification, as measured by electron-beam computed tomography, is quite common in patients with end-stage renal disea se who are treated with dialysis, the clinical significance of these findin gs remain uncertain. In the general population, electron-beam computed tomo graphy evidence of coronary calcification serves as a useful index of ather osclerotic burden and has value as a predictor of adverse coronary events. The relationship between coronary artery calcification and atherosclerotic cardiovascular disease has not been adequately studied. however. in patient s with end-stage renal disease, and calcification scores in this population may reflect both intimal and medial wall calcification. Assessments using coronary angiography are needed to determine the diagnostic value of electr on-beam computed tomography as a predictor of atherosclerotic cardiovascula r disease in patients with chronic renal failure. Nevertheless, electron-be am computed tomography makes it possible to detect the presence and monitor the progression of coronary calcification in those undergoing long-term di alysis. The technique may provide important information about the impact of new therapeutic strategies aimed at reducing the risks of vascular calcifi cation in those with chronic renal failure. Curr Opin Nephrol Hypertens 10: 365-369. (C) 2001 Lippjncott Williams & Wilkins.