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CLINICAL STUDY: END-STAGE RENAL DESIGN

Cardiac calcification in adult hemodialysis patients

A link between end-stage renal disease and cardiovascular disease?

Paolo Raggi, MD^*,1, Amy Boulay, MPH^,1, Scott Chasan-Taber, PhD^,1, Naseem Amin, MD^¶,1, Maureen Dillon, MA^,1, Steven K. Burke, MD^,1 and Glenn M. Chertow, MD, MPH^#,*,1

^* Section of Cardiology, Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
GelTex Pharmaceuticals, Inc, Waltham, Massachusetts, USA
Boston Biostatistics, Inc, Cambridge, Massachusetts, USA
^¶ Genzyme, Inc, Cambridge, Massachusetts, USA
^# Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA

Manuscript received June 13, 2001; revised manuscript received October 16, 2001, accepted November 13, 2001.

^* Reprint requests and correspondence: Glenn M. Chertow, MD, MPH, Department of Medicine Research UCSF Laurel Heights, 3333 California Street, Suite 430, San Francisco, California 94118-1211, USA.
chertowg{at}medicine.ucsf.edu

	Abstract

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OBJECTIVES: We sought to determine clinical and laboratory correlates of calcification of the coronary arteries (CAs), aorta and mitral and aortic valves in adult subjects with end-stage renal disease (ESRD) receiving hemodialysis.

BACKGROUND: Vascular calcification is known to be a risk factor for ischemic heart disease in non-uremic individuals. Patients with ESRD experience accelerated vascular calcification, due at least in part to dysregulation of mineral metabolism. Clinical correlates of the extent of calcification in ESRD have not been identified. Moreover, the clinical relevance of calcification as measured by electron-beam tomography (EBT) has not been determined in the ESRD population.

METHODS: We conducted a cross-sectional analysis of 205 maintenance hemodialysis patients who received baseline EBT for evaluation of vascular and valvular calcification. We compared subjects with and without clinical evidence of atherosclerotic vascular disease and determined correlates of the extent of vascular and valvular calcification using multivariable linear regression and proportional odds logistic regression analyses.

RESULTS: The median coronary artery calcium score was 595 (interquartile range, 76 to 1,600), values consistent with a high risk of obstructive coronary artery disease in the general population. The CA calcium scores were directly related to the prevalence of myocardial infarction (p < 0.0001) and angina (p < 0.0001), and the aortic calcium scores were directly related to the prevalence of claudication (p = 0.001) and aortic aneurysm (p = 0.02). The extent of coronary calcification was more pronounced with older age, male gender, white race, diabetes, longer dialysis vintage and higher serum concentrations of calcium and phosphorus. Total cholesterol (and high-density lipoprotein and low-density lipoprotein subfractions), triglycerides, hemoglobin and albumin were not significantly related to the extent of CA calcification. Only dialysis vintage was significantly associated with the prevalence of valvular calcification.

CONCLUSIONS: Coronary artery calcification is common, severe and significantly associated with ischemic cardiovascular disease in adult ESRD patients. The dysregulation of mineral metabolism in ESRD may influence vascular calcification risk.

Abbreviations and Acronyms   ASVD   atherosclerotic vascular disease   CA   coronary artery   CAD   coronary artery disease   EBT   electron-beam tomography   ESRD   end-stage renal disease   HDL   high-density lipoprotein   LDL   low-density lipoprotein   MI   myocardial infarction   PTH   parathyroid hormone

In the context of a randomized clinical trial comparing two classes of phosphate binders, we obtained baseline electron-beam tomography (EBT) scans on 205 patients receiving maintenance hemodialysis. The main goals of this analysis were to determine whether cardiovascular disease was related to the vascular calcification scores derived by EBT and to determine clinical correlates of the extent of CA, aortic and valvular calcification in this population.

	Methods

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Subjects.   Subjects were adult (age >18 years) patients receiving maintenance hemodialysis enrolled in a randomized clinical trial comparing calcium-based phosphate binders (calcium carbonate or calcium acetate) with sevelamer hydrochloride, a non-calcium, non-aluminum-containing polymer. There were 15 participating dialysis centers: seven in the U.S. and eight in western Europe. Subjects with the following history were excluded from participation: serious gastrointestinal disease (including dysphagia, active untreated gastroparesis, severe motility disorder, major intestinal surgery, markedly irregular bowel function), ethanol or drug dependence or abuse, active malignancy, HIV infection, vasculitis, severe hyperphosphatemia (defined as consistently having a serum phosphorus concentration >8.0 mg/dL, due to poor adherence with phosphate binders), or those whose diabetes mellitus or hypertension was so poorly controlled as to interfere with the conduct of the study as deemed by the investigator. Baseline data on demographic, dialysis-specific and clinical characteristics were obtained, as were a variety of biochemical parameters (including serum phosphorus, calcium, intact parathyroid hormone [PTH], and total, high-density and low-density lipoprotein cholesterol [HDL and LDL], and triglycerides). The LDL level was calculated using Friedewald’s formula (12). Atherosclerotic vascular disease (ASVD) was documented by the clinical diagnoses of coronary artery disease (CAD) (a history of myocardial infarction [MI] or angina pectoris, or evidence of obstructive disease by angiography), cerebrovascular disease (a history of thrombotic stroke or transient ischemic attack) and peripheral vascular disease (a history of claudication, lower extremity revascularization or aortic aneurysm). Written informed consent was obtained from all subjects. The study was conducted in compliance with the recommendations of the Committees on Human Research at each of the participating medical centers (see Appendix).

Imaging procedure.   All subjects underwent an EBT imaging procedure on a C-100 or C-150 scanner (Imatron; South San Francisco, California). Imaging was performed with a 100-ms scanning time and a single-slice thickness of 3 mm. Thirty-six to 40 tomographic slices were obtained for each subject during two breath-holding periods for the C-100 scanner and a single breath-holding period for the C-150 scanner. Tomographic imaging was electrocardiographically triggered at 60% or 80% of the R-R interval (according to each individual imaging center’s protocol) and proceeded from the level of the carina to the diaphragm. Thus, this imaging protocol prevented the visualization of a portion of the aortic arch. All areas of calcification with a minimal density of 130 Hounsfield units within the borders of the CAs, aorta, mitral and aortic valves were computed. A calcified plaque was considered present if at least three contiguous pixels with a density of 130 Hounsfield units were measured (an area equivalent to 1.03 mm²). The radiation exposure from one EBT scan is approximately 1 rem.

The acquired images were reviewed on a NetraMD workstation (ScImage; Los Altos, California). The total volume and density of calcification were derived in the following areas: 1) CAs (left main, left anterior descending, left circumflex and right CA); 2) aorta (with the exclusion of the top portion of the aortic arch that was not included because of the imaging protocol used); and the 3) mitral and 4) aortic valves. The calcium score originally described by Agatston et al. (13) was calculated. The "Agatston score" incorporates the density of calcification, multiplying the calcification volume by a weighted density coefficient (13).

Scans were considered of acceptable research quality only if the images were free from artifacts due to motion, respiration or asynchronous electrocardiographic triggering. Repeat scanning was required in only one case. To ensure the continuity and consistency of the calcium score interpretation, a single expert investigator unaware of the subjects’ clinical status reviewed all EBT scans.

Statistical analysis.   For descriptive purposes, subjects were classified into four coronary calcification groups: none (calcium score = 0), mild to moderate (calcium score = 1 to 400), severe (calcium score = 401 to 1,000) and very severe (calcium score >1,000). This classification is a modification of the categorization proposed by Rumberger et al. (14), who recommended dividing CA calcification scores into four categories. Calcium scores <10 indicate the presence of minimal atherosclerotic plaque. Calcification scores between 11 and 100 indicate mild plaque burden. These two groups experience a low likelihood of obstructive CAD. Calcium scores between 101 and 400 indicate moderate plaque burden and a relatively high likelihood of CAD. Finally, calcium scores >400 indicate severe and extensive atherosclerotic disease. Patients with calcification scores in this range are very likely to have obstructive CAD, with a high risk of developing symptomatic myocardial ischemia (14). For this study, the classification was modified to accommodate the more extensive degree of calcification observed in the hemodialysis population. Therefore, the mild and moderate categories were combined into a single category. Additionally, a fourth category, "very severe," was created to categorize those subjects with markedly elevated calcium scores.

Baseline characteristics were described using conventional descriptive statistics such as mean ± standard deviation, median ± interquartile range and proportions. Correlation between sites of calcification was described with the Spearman correlation coefficient. To evaluate whether EBT had prognostic value in the hemodialysis population, we used the Wilcoxon rank sum test to examine the associations among CA and aortic calcium scores with cardiovascular (i.e., MI, angina pectoris) and peripheral vascular disease (i.e., claudication or lower extremity revascularization, aortic aneurysm) outcomes. Linear regression analysis was conducted in the 170 subjects with evidence of CA calcification (and the 164 subjects with evidence of aortic calcification), to investigate whether the extent of calcification was related to any demographic, clinical or laboratory variables. The calcium scores were highly right-skewed, and therefore, log-transformed prior to inference testing. Age, gender, race, diabetes and dialysis vintage (time since the initiation of dialysis) were included in all models. Smoking status, vitamin D usage, prior parathyroidectomy, and screening serum albumin, hemoglobin, phosphorus, calcium, PTH, and lipids (total, HDL, LDL cholesterol and triglycerides) were candidate variables in multivariable analyses. Variables denoting the presence or absence of vascular disease were not included in the model building process, as they may have resulted from, rather than caused, calcification. As a confirmatory approach, we used proportional odds logistic regression to estimate the associations among categories of calcium score and candidate explanatory variables. This approach allowed the inclusion of all subjects. The proportional odds assumption was tested and deemed non-significant using the Score test (15).

All reported p values are based on two-tailed tests of statistical significance. Analyses were conducted using SAS 6.12 (SAS Institute; Cary, North Carolina).

	Results

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Baseline subject characteristics are outlined in Table 1. Demographic characteristics of the study sample were similar to the general ESRD population in the U.S. and Europe. Calcification of the CAs, aorta and mitral and aortic valves was frequent and severe (see below). Figure 1 shows an example of calcium deposition in the CAs of an asymptomatic individual extracted from the general population (Fig. 1A) and a subject with ESRD (Fig. 1B).

View larger version (110K): [in this window] [in a new window]   Figure 1 The subject in Figure 1A is a 68-year-old healthy female volunteer with calcification in the middle left anterior coronary artery (white arrow) and a total CA calcium score of 45 (approximately 50th percentile for age and gender). The patient with ESRD in Figure 1B is a 70-year-old woman with extensive calcification in the middle and distal left anterior CA (black arrow). The CA calcium score was 374, corresponding to >90th percentile for age and gender.

View larger version (29K): [in this window] [in a new window]   Figure 2 The prevalence of atherosclerotic vascular disease by CA calcium score category.

Table 4 shows the linear regression results. Calcification was more pronounced with older age, male gender, non-black race, diabetes, longer dialysis vintage and higher serum concentrations of calcium and phosphorus. This model explained 36% of the variance in CA calcification. Notably, tobacco use, lipids, PTH, and serum albumin and hemoglobin (markers of overall health in the hemodialysis population) were not significantly related to the extent of CA calcification. Since age, gender, race, diabetes and vintage are immutable, it is worth considering the associations of serum calcium and phosphorus on calcification relative to these other factors. For example, a 1-mg/dL higher serum calcium value corresponds to the same increase in calcification as more than five years (63.5 months) of receiving dialysis; a 1-mg/dL higher serum phosphorus corresponds to the same increase in calcification as nearly 2 1/2 years (28.8 months).

Aortic calcification.   The median aortic calcium score was 629 (interquartile range, 25 to 3,662). Subjects with claudication (p = 0.001) and a known aneurysm (p = 0.02) had significantly higher aortic calcium scores than subjects without these conditions.

Multivariable linear regression analysis was conducted using the log-transformed aortic calcium score as the dependent variable. When added individually to the core model (age, age squared, gender, race, diabetes and dialysis vintage), serum phosphorus (p = 0.007) and PTH (p = 0.006) were significantly associated with aortic calcification, although serum calcium (p = 0.92) was not. Table 5 shows the multivariable linear regression results, adjusting simultaneously for these factors. The model R² was 0.50. In contrast to the CA model, gender and diabetes were not significantly associated with the extent of aortic calcification.

Mitral and aortic valve calcification.   Valvular calcification was less frequent than vascular calcification in general. Nevertheless, the prevalence and extent of valvular calcification were remarkable. Forty-five percent of subjects had calcification of the mitral valve, and 34% of subjects had calcification of the aortic valve, compared with an expected prevalence of 3% to 5% in the general population (17). Twenty-one percent of subjects had calcification of both valves. Aortic and mitral valve calcification scores were directly but relatively weakly correlated with each other (Spearman r = 0.30, p < 0.0001) and with coronary calcification (mitral valve r = 0.35, aortic valve r = 0.28, p < 0.0001). Coronary artery and aorta calcification were more strongly correlated (r = 0.60, p < 0.0001).

Unlike calcification of the CAs or aorta, there were few clinical predictors of the presence or extent of valvular calcification. Whether by standard logistic regression with the presence or absence of calcification as the dependent variable, or proportional odds logistic regression (comparing the odds of having two vs. one vs. no calcified valves), only dialysis vintage was significantly associated with valvular calcification risk. Linear regression analysis in the smaller subset of patients with valvular calcification (aortic and/or mitral) demonstrated no significant correlates (demographic, clinical or laboratory) of the valvular calcification scores.

	Discussion

Top Abstract Methods Results Discussion APPENDIX References

 
Herein we describe EBT findings in 205 adult patients receiving maintenance hemodialysis. There was a high prevalence of calcification of the CAs, aorta and cardiac valves, and though the range was wide, the majority of patients showed coronary calcification to a degree far greater than expected for age- and gender-matched individuals in the normal population. Furthermore, the prevalence of preexisting cardiovascular disease was proportional to the severity of vascular calcification.

Coronary artery calcium and cardiovascular disease.   Coronary calcium is a highly sensitive marker of underlying atherosclerotic disease (18–20), and coronary calcification has been shown to be associated with cardiovascular events in individuals unaffected by renal disease (16,21,22). Margolis et al. (23) reported that patients with coronary calcification visualized by fluoroscopy during coronary angiography had a five-year survival rate of 58% compared with 87% for patients without calcification. The negative prognostic significance of CA calcification appeared to be independent of the severity of coronary luminal obstruction seen on angiography. Detrano et al. (24) showed that among 1,461 patients undergoing coronary angiography, those with coronary calcium in more than one vessel by EBT were 2.2 times more likely to suffer a cardiovascular event than subjects with no calcified vessels. Several additional reports of asymptomatic patients have also indicated that the relative risk of coronary events is significantly increased in the presence of coronary calcification. Raggi et al. (16) demonstrated that an elevated age- and gender-specific calcium score percentile was the most powerful predictor of MI and death. Indeed, the EBT calcium score adds incremental prognostic value above and beyond other "traditional" risk factors for CAD (25).

Previous use of EBT in ESRD.   Braun et al. (26) previously evaluated 49 ESRD patients with EBT imaging. These investigators observed that the extent of coronary calcification in ESRD was significantly greater than in non-ESRD patients with established CAD. In 39 children and young adults with ESRD, Goodman et al. (11) found CA calcification in 36%. Calcification was clearly related to age (calcification in 0 of 23 patients <20 years, and 14 of 16 patients 20 to 30 years of age). Dialysis vintage (time since initiation of dialysis), body mass index, serum albumin, the calcium-phosphorus product and the prescribed dose of oral calcium were also associated with calcification. No multivariable analyses were conducted.

Our findings extend those of Braun et al. (26) and Goodman et al. (11). With a larger cohort of adult hemodialysis patients, we found that advanced age, male gender, diabetes, vintage and the serum concentrations of calcium and phosphorus were all significantly and independently associated with the extent of CA calcification. There was also a trend toward increased calcification among non-black compared with black subjects. There were no significant associations among lipid levels, PTH, albumin, or hemoglobin and the extent of CA calcification.

Study limitations.   Misclassification bias is the major limitation of this study. We may have missed significant associations among certain laboratory variables and vascular calcification, as a single baseline laboratory value may not reflect the time-averaged exposure. Misclassification may have lessened the strength of some of the significant predictors of calcification, especially those that vary widely day-to-day (e.g., serum phosphorus). The exclusion of subjects with uncontrolled diabetes and/or hypertension probably resulted in a study sample with less severe overall calcification than an unselected hemodialysis population. The study sample was also biased by the exclusion of subjects with severe hyperphosphatemia. Their inclusion might have strengthened the association between serum phosphorus and the extent of calcification.

Obviously, the cross-sectional design does not allow causal inference. However, since serum phosphorus and calcium have been directly correlated with mortality in patients with ESRD (8), these findings support the hypothesis that cardiovascular calcification might be modifiable based on the degree to which one could control or prevent dysregulation of mineral metabolism associated with ESRD and dialysis therapy. The absence of an association between lipids and cardiovascular calcification does not necessarily indicate that dyslipidemia is of less importance in this population than in others, because confounding by nutritional status, as well as inflammatory and liver diseases may mask such an association.

Summary.   Vascular and valvular calcifications are common and severe in the adult hemodialysis population. Prospective observational studies, and clinical trials aimed at modifying the course of calcification, will be required to better understand the link between calcification and cardiovascular outcomes in ESRD and to determine whether renal disease, dialysis, or both, are responsible for the excessive degree of calcification in this population.

	APPENDIX

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Study sites and investigators.  

University of California San Francisco, G.M. Chertow, G. Caputo

Beth Israel Deaconess Medical Center, A. Kuhlik, M. Derman, M. Clouse

Mayo Clinic, J.T. McCarthy, J. Breen

Rogosin Institute, J. Silberzweig, J. Markisz

University of California Los Angeles, W. Goodman, J. Goldin

Dallas Nephrology Associates, R. Toto, M. Boyce

Heidelberg, J. Bommer, M. Georgi

Berlin, R. Krause, G. Asmus, B. Hamm

Hanover, R. Brunkhorst

Bochum, D.H.W. Grönemeyer

Bamberg, W. Schulz

Nurnberg, J. Braun

Erlangen, W. Moshage

Graz, H. Holzer, R. Rienmüller

	Footnotes

 
Funding provided by Genzyme, Inc.

¹ Dr. Burke, Ms. Dillon, and Ms. Boulay are employees of GelTex Pharmaceuticals, Inc, a subsidiary of Genzyme, Inc. Dr. Amin is an employee of Genzyme, Inc. All have equity interest in Genzyme, Inc. Drs. Raggi, Chasan-Taber, and Chertow have no equity interest in Genzyme, Inc. Dr. Raggi and Dr. Chertow serve on the Physician Advisory Board of Genzyme, Inc. Dr. Chasan-Taber works for a firm retained by Genzyme, Inc for statistical analysis of clinical trials.

	References

Top Abstract Methods Results Discussion APPENDIX References

 
1. US Renal Data System. USRDS 2000 Annual Report. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.

2. Jones CA, McQuillan GM, Kusek JW, et al. Serum creatinine levels in the US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis. 1998;32:992–999[Medline]

3. Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis. 1998;32(Suppl):S112–S119[Medline]

4. Becker BN, Himmelfarb J, Henrich WL, Hakim RM. Reassessing the cardiac risk profile in chronic hemodialysis patients: A hypothesis on the role of oxidant stress and other non-traditional risk factors. J Am Soc Nephrol. 1997;8:475–486[Medline]

5. Oda H, Keane WF. Lipid abnormalities in end-stage renal disease. Nephrol Dial Transplant. 1998;13:45–49[Abstract/Free Full Text]

6. Bostom AG, Lathrop L. Hyperhomocysteinemia in end-stage renal disease: Prevalence, etiology, and potential relationship to arteriosclerotic outcomes. Kidney Int. 1997;52:10–20[Medline]

7. Nishizawa Y, Shoji T, Kawagishi T, Morii H. Atherosclerosis in uremia: Possible roles of hyperparathyroidism and intermediate density lipoprotein accumulation. Kidney Int. 1997;62(Suppl):S90–S92

8. Block GA, Hulbert-Shearon TE, Levin NW, Port FK. Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: A national study. Am J Kidney Dis. 1998;31:601–617

9. US Renal Data System. USRDS 1998 Annual Report. Chapter IV. Medication use among dialysis patients in the DMMS. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.

10. Ginsburg ES, Walsh B, Greenberg L, Price D, Chertow GM, Owen WF Jr. Effects of estrogen replacement therapy on the lipoprotein profile in postmenopausal women with ESRD. Kidney Int. 1998;54:1344–1350[CrossRef][Medline]

11. Goodman WG, Goldin J, Kuizon BD, et al. Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med. 2000;342:1478–1483[Abstract/Free Full Text]

12. Nauck M, Kramer-Guth A, Bartens W, Marz W, Wieland H, Wanner C. Is the determination of LDL cholesterol according to Friedewald accurate in CAPD and HD patients? Clin Nephrol. 1996;46:319–325[Medline]

13. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15:827–832[Abstract]

14. Rumberger JA, Brundage BH, Rader DJ, Kondos G. Electron beam computed tomographic coronary calcium scanning: A review of guidelines on use in asymptomatic persons. Mayo Clin Proc. 1999;74:243–252[Abstract]

15. McCullagh P, Nelder JA. Generalized Linear Models. 2nd ed. : Chapman & Hall; 1989. p. 151–155

16. Raggi P, Callister TQ, Cooil B, et al. Identification of patients at increased risk of first unheralded acute myocardial infarction by electron beam computed tomography. Circulation. 2000;101:850–855[Abstract/Free Full Text]

17. Otto CM, Lind BK, Kitzman DW, Gersh BJ, Siscovick DS. Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med. 1999;341:142–147[Abstract/Free Full Text]

18. Simons DB, Schwartz RS, Edwards WD, Sheedy PF, Breen JF, Rumberger JA. Noninvasive definition of anatomic coronary artery disease by ultrafast computed tomographic scanning: A quantitative pathologic comparison study. J Am Coll Cardiol. 1992;20:1118–1126[Abstract]

19. Sangiorgi G, Rumberger JA, Severson A, et al. Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: A histologic study of 723 coronary artery segments using non-decalcifying methodology: electron beam computed tomography and coronary artery disease: scanning for coronary artery calcification. J Am Coll Cardiol. 1998;31:126–133[Abstract/Free Full Text]

20. Mautner SL, Mautner GC, Froehlich J, et al. Coronary artery disease: Prediction with in vitro electron beam CT. Radiology. 1994;192:625–630[Abstract/Free Full Text]

21. Arad Y, Spadaro LA, Goodman K, Newstein D, Guerci AD. Prediction of coronary events with electron beam computed tomography. J Am Coll Cardiol. 2000;36:1253–1260[Abstract/Free Full Text]

22. Wong ND, Hsu JC, Detrano RC, Diamond G, Eisenberg H, Gardin JM. Coronary artery calcium evaluation by electron beam computed tomography and its relation to new cardiovascular events. Am J Cardiol. 2000;86:495–498[CrossRef][Medline]

23. Margolis JR, Chen JT, Kong Y, Peter RH, Behar VS, Kisslo JA. The diagnostic and prognostic significance of coronary artery calcification: A report of 800 cases. Radiology. 1980;137:609–616[Abstract/Free Full Text]

24. Detrano RC, Hsiai T, Wang S, et al. Prognostic value of coronary calcification and angiographic stenoses in patients undergoing coronary angiography. J Am Coll Cardiol. 1996;27:285–290[Abstract]

25. Raggi P, Cooil B, Callister TQ. Use of electron beam tomography data to develop models for prediction of hard coronary events. Am Heart J. 2001;141:375–382[CrossRef][Medline]

26. Braun J, Oldendorf M, Moshage W, Heidler R, Zeitler E, Luft FC. Electron beam computed tomography in the evaluation of cardiac calcification in chronic dialysis patients. Am J Kidney Dis. 1996;27:394–401[Medline]

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				N. D. Toussaint, K. K. Lau, B. J. Strauss, K. R. Polkinghorne, and P. G. Kerr Determination and Validation of Aortic Calcification Measurement from Lateral Bone Densitometry in Dialysis Patients Clin. J. Am. Soc. Nephrol., January 1, 2009; 4(1): 119 - 127. [Abstract] [Full Text] [PDF]

				G. Jean, J.-C. Terrat, T. Vanel, J.-M. Hurot, C. Lorriaux, B. Mayor, and C. Chazot Daily oral 25-hydroxycholecalciferol supplementation for vitamin D deficiency in haemodialysis patients: effects on mineral metabolism and bone markers Nephrol. Dial. Transplant., November 1, 2008; 23(11): 3670 - 3676. [Abstract] [Full Text] [PDF]

				S. Fishbane, W. B. Shapiro, D. B. Corry, S. L. Vicks, M. Roppolo, K. Rappaport, X. Ling, W. G. Goodman, S. Turner, and C. Charytan Cinacalcet HCl and Concurrent Low-dose Vitamin D Improves Treatment of Secondary Hyperparathyroidism in Dialysis Patients Compared with Vitamin D Alone: The ACHIEVE Study Results Clin. J. Am. Soc. Nephrol., November 1, 2008; 3(6): 1718 - 1725. [Abstract] [Full Text] [PDF]

				S. Kobayashi, M. Oka, K. Maesato, R. Ikee, T. Mano, M. Hidekazu, and T. Ohtake Coronary Artery Calcification, ADMA, and Insulin Resistance in CKD Patients Clin. J. Am. Soc. Nephrol., September 1, 2008; 3(5): 1289 - 1295. [Abstract] [Full Text] [PDF]

				N. J. Howell, B. E. Keogh, R. S. Bonser, T. R. Graham, J. Mascaro, S. J. Rooney, I. C. Wilson, and D. Pagano Mild renal dysfunction predicts in-hospital mortality and post-discharge survival following cardiac surgery. Eur. J. Cardiothorac. Surg., August 1, 2008; 34(2): 390 - 395. [Abstract] [Full Text] [PDF]

				S. Baroudi, R. A. Qazi, K. L. Lentine, and B. Bastani Infective endocarditis in haemodialysis patients: 16-year experience at one institution NDT Plus, August 1, 2008; 1(4): 253 - 256. [Abstract] [Full Text] [PDF]

				H. Ogata, M. Mizobuchi, F. Koiwa, E. Kinugasa, and T. Akizawa Clinical significance of parathyroid intervention on CKD-MBD management NDT Plus, August 1, 2008; 1(suppl_3): iii9 - iii13. [Abstract] [Full Text] [PDF]

				P. P. How, D. L. Mason, and A. H. Lau Current Approaches in the Treatment of Chronic Kidney Disease Mineral and Bone Disorder Journal of Pharmacy Practice, June 1, 2008; 21(3): 196 - 213. [Abstract] [PDF]

				S. Mathew, K. S. Tustison, T. Sugatani, L. R. Chaudhary, L. Rifas, and K. A. Hruska The Mechanism of Phosphorus as a Cardiovascular Risk Factor in CKD J. Am. Soc. Nephrol., June 1, 2008; 19(6): 1092 - 1105. [Abstract] [Full Text] [PDF]

				P. Raggi and M. Kleerekoper Contribution of Bone and Mineral Abnormalities to Cardiovascular Disease in Patients with Chronic Kidney Disease Clin. J. Am. Soc. Nephrol., May 1, 2008; 3(3): 836 - 843. [Abstract] [Full Text] [PDF]

				N. D. Toussaint, K. K. Lau, B. J. Strauss, K. R. Polkinghorne, and P. G. Kerr Associations between vascular calcification, arterial stiffness and bone mineral density in chronic kidney disease Nephrol. Dial. Transplant., February 1, 2008; 23(2): 586 - 593. [Abstract] [Full Text] [PDF]

				D. A. Bushinsky and P. Messa Efficacy of Early Treatment with Calcimimetics in Combination with Reduced Doses of Vitamin D Sterols in Dialysis Patients NDT Plus, January 1, 2008; 1(suppl_1): i18 - i23. [Abstract] [Full Text] [PDF]

				M. B. Chonchol, V. Aboyans, P. Lacroix, G. Smits, T. Berl, and M. Laskar Long-term outcomes after coronary artery bypass grafting: Preoperative kidney function is prognostic J. Thorac. Cardiovasc. Surg., September 1, 2007; 134(3): 683 - 689. [Abstract] [Full Text] [PDF]

				L. G. Glynn, D. Reddan, J. Newell, J. Hinde, B. Buckley, and A. W. Murphy Chronic kidney disease and mortality and morbidity among patients with established cardiovascular disease: a West of Ireland community-based cohort study Nephrol. Dial. Transplant., September 1, 2007; 22(9): 2586 - 2594. [Abstract] [Full Text] [PDF]

				K. D. Rudser, I. H. de Boer, A. Dooley, B. Young, and B. Kestenbaum Fracture Risk after Parathyroidectomy among Chronic Hemodialysis Patients J. Am. Soc. Nephrol., August 1, 2007; 18(8): 2401 - 2407. [Abstract] [Full Text] [PDF]

				J. Nogueira and M. Weir The Unique Character of Cardiovascular Disease in Chronic Kidney Disease and Its Implications for Treatment with Lipid-Lowering Drugs Clin. J. Am. Soc. Nephrol., July 1, 2007; 2(4): 766 - 785. [Abstract] [Full Text] [PDF]

				T. Stompor AN OVERVIEW OF THE PATHOPHYSIOLOGY OF VASCULAR CALCIFICATION IN CHRONIC KIDNEY DISEASE Perit. Dial. Int., June 1, 2007; 27(Supplement_2): S215 - S222. [Abstract] [Full Text] [PDF]

				A. Y.-M. Wang CARDIOVASCULAR RISK FACTORS IN PERITONEAL DIALYSIS PATIENTS REVISITED Perit. Dial. Int., June 1, 2007; 27(Supplement_2): S223 - S227. [Abstract] [Full Text] [PDF]

				P. Raggi, A. Bellasi, E. Ferramosca, G. A. Block, and P. Muntner Pulse Wave Velocity Is Inversely Related to Vertebral Bone Density in Hemodialysis Patients Hypertension, June 1, 2007; 49(6): 1278 - 1284. [Abstract] [Full Text] [PDF]

				P. Muntner, E. Ferramosca, A. Bellasi, G. A. Block, and P. Raggi Development of a cardiovascular calcification index using simple imaging tools in haemodialysis patients Nephrol. Dial. Transplant., February 1, 2007; 22(2): 508 - 514. [Abstract] [Full Text] [PDF]

				N. D. Toussaint, K. K. Lau, K. R. Polkinghorne, and P. G. Kerr Measurement of vascular calcification using CT fistulograms Nephrol. Dial. Transplant., February 1, 2007; 22(2): 484 - 490. [Abstract] [Full Text] [PDF]

				P. Greenland, R. O. Bonow, B. H. Brundage, M. J. Budoff, M. J. Eisenberg, S. M. Grundy, M. S. Lauer, W. S. Post, P. Raggi, R. F. Redberg, et al. ACCF/AHA 2007 Clinical Expert Consensus Document on Coronary Artery Calcium Scoring By Computed Tomography in Global Cardiovascular Risk Assessment and in Evaluation of Patients With Chest Pain: A Report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) Developed in Collaboration With the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography J. Am. Coll. Cardiol., January 23, 2007; 49(3): 378 - 402. [Full Text] [PDF]

				M.-L. Gross, H.-P. Meyer, H. Ziebart, P. Rieger, U. Wenzel, K. Amann, I. Berger, M. Adamczak, P. Schirmacher, and E. Ritz Calcification of Coronary Intima and Media: Immunohistochemistry, Backscatter Imaging, and X-Ray Analysis in Renal and Nonrenal Patients Clin. J. Am. Soc. Nephrol., January 1, 2007; 2(1): 121 - 134. [Abstract] [Full Text] [PDF]

				S. Mathew, R. J. Lund, F. Strebeck, K. S. Tustison, T. Geurs, and K. A. Hruska Reversal of the Adynamic Bone Disorder and Decreased Vascular Calcification in Chronic Kidney Disease by Sevelamer Carbonate Therapy J. Am. Soc. Nephrol., January 1, 2007; 18(1): 122 - 130. [Abstract] [Full Text] [PDF]

				A. L.M. de Francisco, C. Pinera, R. Palomar, and M. Arias Impact of Treatment with Calcimimetics on Hyperparathyroidism and Vascular Mineralization J. Am. Soc. Nephrol., December 1, 2006; 17(12_suppl_3): S281 - S285. [Abstract] [Full Text] [PDF]

				G. L. Schwartz and S. C. Textor Early Referral for Chronic Kidney Disease: Good for Those Who Need It, but Who Are They? Mayo Clin. Proc., November 1, 2006; 81(11): 1420 - 1422. [Full Text] [PDF]

				V. C Dennis and G. L Albertson Doxercalciferol Treatment of Secondary Hyperparathyroidism Ann. Pharmacother., November 1, 2006; 40(11): 1955 - 1965. [Abstract] [Full Text] [PDF]

				C. Tomiyama, A. Higa, M. A. Dalboni, M. Cendoroglo, S. A. Draibe, L. Cuppari, A. B. Carvalho, E. M. Neto, and M. E. F. Canziani The impact of traditional and non-traditional risk factors on coronary calcification in pre-dialysis patients Nephrol. Dial. Transplant., September 1, 2006; 21(9): 2464 - 2471. [Abstract] [Full Text] [PDF]

				J. R. Wu-Wong, W. Noonan, J. Ma, D. Dixon, M. Nakane, A. L. Bolin, K. A. Koch, S. Postl, S. J. Morgan, and G. A. Reinhart Role of Phosphorus and Vitamin D Analogs in the Pathogenesis of Vascular Calcification J. Pharmacol. Exp. Ther., July 1, 2006; 318(1): 90 - 98. [Abstract] [Full Text] [PDF]

				H. Yoshida, K. Yokoyama, Y. Maruvama, H. Yamanoto, S. Yoshida, and T. Hosoya Investigation of coronary artery calcification and stenosis by coronary angiography (CAG) in haemodialysis patients Nephrol. Dial. Transplant., May 1, 2006; 21(5): 1451 - 1452. [Full Text] [PDF]

				D. Yuen, A. Pierratos, R. M.A. Richardson, and C. T. Chan The natural history of coronary calcification progression in a cohort of nocturnal haemodialysis patients Nephrol. Dial. Transplant., May 1, 2006; 21(5): 1407 - 1412. [Abstract] [Full Text] [PDF]

				X. Li, H.-Y. Yang, and C. M. Giachelli Role of the Sodium-Dependent Phosphate Cotransporter, Pit-1, in Vascular Smooth Muscle Cell Calcification Circ. Res., April 14, 2006; 98(7): 905 - 912. [Abstract] [Full Text] [PDF]

				M. Arici, S. Kahraman, G. Genctoy, B. Altun, U. Kalyoncu, A. Oto, S. Kirazli, Y. Erdem, U. Yasavul, and C. Turgan Association of mineral metabolism with an increase in cellular adhesion molecules: another link to cardiovascular risk in maintenance haemodialysis? Nephrol. Dial. Transplant., April 1, 2006; 21(4): 999 - 1005. [Abstract] [Full Text] [PDF]

				M. Sigrist, P. Bungay, M. W. Taal, and C. W. McIntyre Vascular calcification and cardiovascular function in chronic kidney disease Nephrol. Dial. Transplant., March 1, 2006; 21(3): 707 - 714. [Abstract] [Full Text] [PDF]

				I. Lopez, E. Aguilera-Tejero, F. J. Mendoza, Y. Almaden, J. Perez, D. Martin, and M. Rodriguez Calcimimetic R-568 Decreases Extraosseous Calcifications in Uremic Rats Treated with Calcitriol J. Am. Soc. Nephrol., March 1, 2006; 17(3): 795 - 804. [Abstract] [Full Text] [PDF]

				K. Jindal, C. T. Chan, C. Deziel, D. Hirsch, S. D. Soroka, M. Tonelli, and B. F. Culleton CHAPTER 3: Mineral Metabolism J. Am. Soc. Nephrol., March 1, 2006; 17(3_suppl_1): S11 - S15. [Full Text] [PDF]

				V. Lorenzo, A. Martin-Malo, R. Perez-Garcia, J. V. Torregrosa, N. Vega, A. L. M. de Francisco, and A. Cases Prevalence, clinical correlates and therapy cost of mineral abnormalities among haemodialysis patients: a cross-sectional multicentre study Nephrol. Dial. Transplant., February 1, 2006; 21(2): 459 - 465. [Abstract] [Full Text] [PDF]

				G. Jean, C. Chazot, and B. Charra Hyperphosphataemia and related mortality Nephrol. Dial. Transplant., February 1, 2006; 21(2): 273 - 280. [Full Text] [PDF]

				C. S. Fox, M. G. Larson, R. S. Vasan, C.-Y. Guo, H. Parise, D. Levy, E. P. Leip, C. J. O'Donnell, R. B. D'Agostino Sr., and E. J. Benjamin Cross-Sectional Association of Kidney Function with Valvular and Annular Calcification: The Framingham Heart Study J. Am. Soc. Nephrol., February 1, 2006; 17(2): 521 - 527. [Abstract] [Full Text] [PDF]

				R. W. Schrier Role of Diminished Renal Function in Cardiovascular Mortality: Marker or Pathogenetic Factor? J. Am. Coll. Cardiol., January 3, 2006; 47(1): 1 - 8. [Abstract] [Full Text]

				M. Nakasuji, S. Nishi, K. Nakasuji, N. Hamaoka, K. Ikeshita, and A. Asada Duration of Dialysis Is a Significant Predictor of Prolonged Postoperative Mechanical Ventilation in Dialysis-Dependent Patients Undergoing Cardiac Surgery Anesth. Analg., January 1, 2006; 102(1): 2 - 7. [Abstract] [Full Text] [PDF]

				M. Morena, N. Terrier, I. Jaussent, H. Leray-Moragues, L. Chalabi, J.-P. Rivory, F. Maurice, C. Delcourt, J.-P. Cristol, B. Canaud, et al. Plasma Osteoprotegerin Is Associated with Mortality in Hemodialysis Patients J. Am. Soc. Nephrol., January 1, 2006; 17(1): 262 - 270. [Abstract] [Full Text] [PDF]

				H. Taniwaki, E. Ishimura, T. Tabata, Y. Tsujimoto, A. Shioi, T. Shoji, M. Inaba, T. Inoue, and Y. Nishizawa Aortic calcification in haemodialysis patients with diabetes mellitus Nephrol. Dial. Transplant., November 1, 2005; 20(11): 2472 - 2478. [Abstract] [Full Text] [PDF]

				W. Y. Qunibi Reducing the Burden of Cardiovascular Calcification in Patients with Chronic Kidney Disease J. Am. Soc. Nephrol., November 1, 2005; 16(11_suppl_2): S95 - S102. [Abstract] [Full Text] [PDF]

				C. R. Nolan Strategies for Improving Long-Term Survival in Patients with ESRD J. Am. Soc. Nephrol., November 1, 2005; 16(11_suppl_2): S120 - S127. [Abstract] [Full Text] [PDF]

				R. Zakeri, N. Freemantle, V. Barnett, G. W. Lipkin, R. S. Bonser, T. R. Graham, S. J. Rooney, I. C. Wilson, R. Cramb, B. E. Keogh, et al. Relation Between Mild Renal Dysfunction and Outcomes After Coronary Artery Bypass Grafting Circulation, August 30, 2005; 112(9_suppl): I-270 - I-275. [Abstract] [Full Text] [PDF]

				I. B. Salusky, W. G. Goodman, S. Sahney, B. Gales, A. Perilloux, H.-J. Wang, R. M. Elashoff, and H. Juppner Sevelamer Controls Parathyroid Hormone-Induced Bone Disease as Efficiently as Calcium Carbonate without Increasing Serum Calcium Levels during Therapy with Active Vitamin D Sterols J. Am. Soc. Nephrol., August 1, 2005; 16(8): 2501 - 2508. [Abstract] [Full Text] [PDF]

				M. R. Davies, Richard. J. Lund, S. Mathew, and K. A. Hruska Low Turnover Osteodystrophy and Vascular Calcification Are Amenable to Skeletal Anabolism in an Animal Model of Chronic Kidney Disease and the Metabolic Syndrome J. Am. Soc. Nephrol., April 1, 2005; 16(4): 917 - 928. [Abstract] [Full Text] [PDF]

				J. S. Lindberg, B. Culleton, G. Wong, M. F. Borah, R. V. Clark, W. B. Shapiro, S. D. Roger, F. E. Husserl, P. S. Klassen, M. D. Guo, et al. Cinacalcet HCl, an Oral Calcimimetic Agent for the Treatment of Secondary Hyperparathyroidism in Hemodialysis and Peritoneal Dialysis: A Randomized, Double-Blind, Multicenter Study J. Am. Soc. Nephrol., March 1, 2005; 16(3): 800 - 807. [Abstract] [Full Text] [PDF]

				A. Y.-M. Wang, S. S.-Y. Ho, M. Wang, E. K.-H. Liu, S. Ho, P. K.-T. Li, S.-F. Lui, and J. E. Sanderson Cardiac Valvular Calcification as a Marker of Atherosclerosis and Arterial Calcification in End-stage Renal Disease Arch Intern Med, February 14, 2005; 165(3): 327 - 332. [Abstract] [Full Text] [PDF]

				G. M. Chertow and S. M. Moe Calcification or Classification? J. Am. Soc. Nephrol., February 1, 2005; 16(2): 293 - 295. [Full Text] [PDF]

				B. Kestenbaum, J. N. Sampson, K. D. Rudser, D. J. Patterson, S. L. Seliger, B. Young, D. J. Sherrard, and D. L. Andress Serum Phosphate Levels and Mortality Risk among People with Chronic Kidney Disease J. Am. Soc. Nephrol., February 1, 2005; 16(2): 520 - 528. [Abstract] [Full Text] [PDF]

				L. G. Bongartz, M. J. Cramer, P. A. Doevendans, J. A. Joles, and B. Braam The severe cardiorenal syndrome: 'Guyton revisited' Eur. Heart J., January 1, 2005; 26(1): 11 - 17. [Abstract] [Full Text] [PDF]

				Z. A. Massy, O. Ivanovski, T. Nguyen-Khoa, J. Angulo, D. Szumilak, N. Mothu, O. Phan, M. Daudon, B. Lacour, T. B. Drueke, et al. Uremia Accelerates both Atherosclerosis and Arterial Calcification in Apolipoprotein E Knockout Mice J. Am. Soc. Nephrol., January 1, 2005; 16(1): 109 - 116. [Abstract] [Full Text] [PDF]

				H. H. Jung, K. R. Ma, and H. Han Elevated concentrations of cardiac troponins are associated with severe coronary artery calcification in asymptomatic haemodialysis patients Nephrol. Dial. Transplant., December 1, 2004; 19(12): 3117 - 3123. [Abstract] [Full Text] [PDF]

				C. M. Giachelli Vascular Calcification Mechanisms J. Am. Soc. Nephrol., December 1, 2004; 15(12): 2959 - 2964. [Abstract] [Full Text] [PDF]

				M. S Joy, A. V Kshirsagar, and N. Franceschini Calcimimetics and the Treatment of Primary and Secondary Hyperparathyroidism Ann. Pharmacother., November 1, 2004; 38(11): 1871 - 1880. [Abstract] [Full Text] [PDF]

				M. E. Lockhart, M. L. Robbin, M. M. McNamara, and M. Allon Association of pelvic arterial calcification with arteriovenous thigh graft failure in haemodialysis patients Nephrol. Dial. Transplant., October 1, 2004; 19(10): 2564 - 2569. [Abstract] [Full Text] [PDF]

				A. S. Go, G. M. Chertow, D. Fan, C. E. McCulloch, and C.-y. Hsu Chronic Kidney Disease and the Risks of Death, Cardiovascular Events, and Hospitalization N. Engl. J. Med., September 23, 2004; 351(13): 1296 - 1305. [Abstract] [Full Text] [PDF]

				S. M. Moe and N. X. Chen Pathophysiology of Vascular Calcification in Chronic Kidney Disease Circ. Res., September 17, 2004; 95(6): 560 - 567. [Abstract] [Full Text] [PDF]

				A. A. Haydar, N. M. A. Hujairi, A. A. Covic, D. Pereira, M. Rubens, and D. J. A. Goldsmith Coronary artery calcification is related to coronary atherosclerosis in chronic renal disease patients: a study comparing EBCT-generated coronary artery calcium scores and coronary angiography Nephrol. Dial. Transplant., September 1, 2004; 19(9): 2307 - 2312. [Abstract] [Full Text] [PDF]

				S. M. Moe, K. D. O'Neill, M. Resterova, N. Fineberg, S. Persohn, and C. A. Meyer Natural history of vascular calcification in dialysis and transplant patients Nephrol. Dial. Transplant., September 1, 2004; 19(9): 2387 - 2393. [Abstract] [Full Text] [PDF]

				M. P. Reilly, N. Iqbal, M. Schutta, M. L. Wolfe, M. Scally, A. R. Localio, D. J. Rader, and S. E. Kimmel Plasma Leptin Levels Are Associated with Coronary Atherosclerosis in Type 2 Diabetes J. Clin. Endocrinol. Metab., August 1, 2004; 89(8): 3872 - 3878. [Abstract] [Full Text] [PDF]

				G. A. Block, P. S. Klassen, J. M. Lazarus, N. Ofsthun, E. G. Lowrie, and G. M. Chertow Mineral Metabolism, Mortality, and Morbidity in Maintenance Hemodialysis J. Am. Soc. Nephrol., August 1, 2004; 15(8): 2208 - 2218. [Abstract] [Full Text] [PDF]

				G. M. London, C. Marty, S. J. Marchais, A. P. Guerin, F. Metivier, and M.-C. de Vernejoul Arterial Calcifications and Bone Histomorphometry in End-Stage Renal Disease J. Am. Soc. Nephrol., July 1, 2004; 15(7): 1943 - 1951. [Abstract] [Full Text] [PDF]

				B. Hoen Infective endocarditis: a frequent disease in dialysis patients Nephrol. Dial. Transplant., June 1, 2004; 19(6): 1360 - 1362. [Full Text] [PDF]

				T. Adragao, A. Pires, C. Lucas, R. Birne, L. Magalhaes, M. Goncalves, and A. P. Negrao A simple vascular calcification score predicts cardiovascular risk in haemodialysis patients Nephrol. Dial. Transplant., June 1, 2004; 19(6): 1480 - 1488. [Abstract] [Full Text] [PDF]

				G. M. Chertow, P. Raggi, S. Chasan-Taber, J. Bommer, H. Holzer, and S. K. Burke Determinants of progressive vascular calcification in haemodialysis patients Nephrol. Dial. Transplant., June 1, 2004; 19(6): 1489 - 1496. [Abstract] [Full Text] [PDF]

				G. A. Block, K. J. Martin, A. L.M. de Francisco, S. A. Turner, M. M. Avram, M. G. Suranyi, G. Hercz, J. Cunningham, A. K. Abu-Alfa, P. Messa, et al. Cinacalcet for Secondary Hyperparathyroidism in Patients Receiving Hemodialysis N. Engl. J. Med., April 8, 2004; 350(15): 1516 - 1525. [Abstract] [Full Text] [PDF]

				A. Yildiz, S. Tepe, H. Oflaz, H. Yazici, H. Pusuroglu, M. Besler, E. Ark, and F. Erzengin Carotid atherosclerosis is a predictor of coronary calcification in chronic haemodialysis patients Nephrol. Dial. Transplant., April 1, 2004; 19(4): 885 - 891. [Abstract] [Full Text] [PDF]

				L. A. Stevens, O. Djurdjev, S. Cardew, E. C. Cameron, and A. Levin Calcium, Phosphate, and Parathyroid Hormone Levels in Combination and as a Function of Dialysis Duration Predict Mortality: Evidence for the Complexity of the Association between Mineral Metabolism and Outcomes J. Am. Soc. Nephrol., March 1, 2004; 15(3): 770 - 779. [Abstract] [Full Text] [PDF]

				R. Dikow and E. Ritz Cardiovascular complications in the diabetic patient with renal disease: an update in 2003 Nephrol. Dial. Transplant., October 1, 2003; 18(10): 1993 - 1998. [Full Text] [PDF]

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