Hyperphosphatemia as a cardiovascular risk factor in chronic renal failure (CRF) patients treated with haemodialysis

Aim of investigation: Assessment of the hyperphosphatemia (HP) as a cardiovascular risk factor in cronic renal failure (CRF) patients treated with haemodialysis. Material and Methods: We observed 125 patients treated with chronic HD during 6 months - 12 years. The patients were divided into 2 groups depending on the HP levels on HD treatment. HD was performed by standard procedure. Adequacy of dialysis was comparable in two groups. Survival analysis was performed by Kaplan-Meier method. Results: We found, that remaining HP in patients treated with HD is a fatal risk factor. 65% patients of the I group had an elevated calcium-phosphate product (Ca × Р > 70). Patients of the II group had a normal calcium-phosphate product (CPP) value. Number of the vitamin D recipients were larger in I group (38,3 vs 9,3). Calcification of the aortic valve, coronary vessels and peripheral soft tissues was determined in 35% of I group patients and only in 12,5% of the II group patients. Ischaemic heart disease (IHD) was diagnosed in I group of dialysis patients significantly more often. Same patients had significantly positive correlation between CPP and constriction extent of the common coronary artery. Arhythmias were registered in 26,8% of I group and only in 7% of II group. We found also direct significant correlation between hypertrophy of the left ventricular (LV) and HP levels. Development of the hypertrophic cardiomyopathy was main cause of the heart failure (HF) as well as IHD in observed patients. Conclusion: HP is an independent negative prognostic factor, increases progression of IHD, aggravates systolic hypertension and LV hypertrophy, increases arhythmias and also acute and overload HF risk. It is necessary to use elevated doses of CaCO3, intensification of dialysis regimen (increase Kt/V) for the HP prophylaxis. It is essential to monitor of the Ca × P product, iPTG levels, acid-base characteristics and to use new aluminium- and calcium-free phosphate binding agents and synthetic analogs of vitamin D2 for the metastasis calcification prophylaxis.

гиперфосфатемия, хронический гемодиализ, кардиоваскулярные осложнения, выживаемость

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