| Theme |
The impact of bone and Ca/Pi metabolism on vascular disease |
| Title |
The roles of phosphate in vascular calcification and management of hyperphosphatemia |
| Author |
Atsushi Shioi |
Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine |
| [ Summary ] |
Hyperphosphatemia and elevated calcium-phosphorus product may play important roles in the progression of vascular calcification and cardiovascular diseases in hemodialysis patients. Inorganic phosphate has been shown to promote in vitro calcification of vascular wall cells by inducing osteo/chondrogenic differentiation through sodium-dependent phosphate co-transport mechanism. Recent in vivo studies suggest cartilaginous metaplasia and endochondral ossification as possible mechanisms by which vascular calcification may occur. Therefore, inorganic phosphate may progress vascular calcification by inducing apoptosis of chondrocytes in cartilaginous tissue formed in arterial walls. It is pointed out that treatment with calcium-containing phosphate binder may predispose to deposition of calcium and phosphate crystals in cardiovascular tissues. Non-calcium-containing phosphate binders such as sevelamer may enable us to maintain appropriate levels of serum phosphorus without excess calcium load and inhibit progression of vascular calcification. |