Original investigationsDialysis therapiesEffects of cyclic intermittent etidronate therapy on coronary artery calcification in patients receiving long-term hemodialysis
Section snippets
Subjects
Of patients undergoing regular hemodialysis at the Dialysis Unit of Takeda General Hospital (Fukushima, Japan), 53 patients agreed to have their CAC score estimated. We excluded 6 patients with obvious acute inflammation and 2 patients who did not comply with their drug therapy. Two patients did not comply adequately with the etidronate regimen. Eight patients were excluded from the study for the following reasons: refusal of follow-up MDCT, 3 patients; transfer to another dialysis unit, 3
Clinical course of control group
Table 1 lists clinical courses of patients without etidronate therapy. The MDCT was performed twice, with a mean interscan period of 388 ± 21 days. This interval between the first and second MDCT scans was compatible with those in the study group (374 days). Median CAC score increased from 1,303 mm3 (range, 231 to 3,133 mm3) to 1,462 mm3 (range, 220 to 3,450 mm3). No significant changes were observed in serum levels of Ca, P, and iPTH (8.8 ± 1.0 versus 8.8 ± 0.9 mg/dL [2.20 ± 0.25 versus 2.20 ±
Discussion
Many investigators were able to establish that atherogenic vascular calcification in patients without ESRD is caused by an active process resembling osteogenesis in bone.17 In this process, vascular smooth muscle cells transform into phenotypically distinct cells capable of calcification in vitro.18 These modified vascular smooth muscle cells facilitate mineralization in vitro by forming nodules similar to those produced by osteoblasts, producing bone-associated proteins, and forming matrix
Acknowledgment
The authors thank Hiroyuki Ashikaga for assessment of CAC score; Masahiro Haga for blood sampling; Keita Matsushita (Sumitomo Pharmaceutical Co, Tokyo, Japan) for help in serum etidronate level measurement; and John P McCormick, PhD, for reviewing the manuscript.
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Supported in part by a grant from the Renal Osteodystrophy Foundation in Japan.