An update on calcium metabolism alterations and cardiovascular risk in patients with chronic kidney disease: questions, myths and facts.

In 2006, the Kidney Disease Improving Global Outcomes (KDIGO) guidelines introduced, for the first time, the definition and diagnostic and therapeutic criteria for a systemic complication of the mineral metabolism dysfunction, such as vascular calcification, caused by chronic renal insufficiency. Abdominal x-ray and echocardiography rather than the more complex CT scan is suggested to make the diagnosis. This condition is associated with high cardiovascular risk and consequent poor prognosis.

Salivary glands: a new player in phosphorus metabolism.

In uremic patients, hyperphosphatemia is associated with cardiovascular calcification and increased cardiovascular mortality. Despite the use of phosphate binders and dietary phosphate limitation in addition to dialysis, only 50% of dialysis patients achieve recommended serum phosphate levels. The identification of other approaches for serum phosphorus reduction is therefore necessary.

Phosphorus: the philosopher's stone discovered in 1669.

Recently the importance in nephrology of phosphorus as phosphate has been highlighted by chronic renal failure patients, in whom the toxic effect of phosphate is widely acknowledged, given the association of phosphate serum level with cardiovascular risk. This association is not limited to chronic renal failure and hemodialysis patients as high serum phosphate. Recently high serum phosphate levels were associated with increased risk for cardiovascular disease in subjects free from chronic kidney disease, and cardiovascular disease as well, and with progression of atherosclerosis.

Salivary phosphorus and phosphate content of beverages: implications for the treatment of uremic hyperphosphatemia.

Background: Hyperphosphatemia provides relevant and dangerous evidence of end-stage renal disease (ESRD) in patients undergoing periodic hemodialysis. The relationship between hyperphosphatemia and cardiovascular calcification, with the consequences of high morbidity and mortality after cardiovascular events, is well-defined. Hyperphosphatemia is treated by dietary limitation of phosphorus ingestion and by phosphate binders, but only half of ESRD patients fall within the range of K/DOQI guidelines.

Phosphate salivary secretion in hemodialysis patients: implications for the treatment of hyperphosphatemia.

Background/aims: Hyperphosphatemia is recognized as contributing to the increased risk of cardiac death in end-stage renal disease (ESRD) and hemodialysis (HD) patients. Currently available pharmacologic treatment for hyperphosphatemia is based on phosphate binders but, despite treatment, only half of the patients fall within the range for serum phosphorus of the K/DOQI guidelines. Therefore, there is a need to identify other therapeutic approaches in order to reduce serum phosphate.