A 57-yr-old Caucasian man with ESRD on HD shows coronary artery calcification on EBCT
By Medcase Editor - md | Sep 19, 2021
A 57-yr-old Caucasian man with chronic kidney disease secondary to hypertension is receiving maintenance hemodialysis therapy. The patient selfreferred for a coronary artery calcification scanusing electron beam computerized tomography (EBCT), although he has no cardiac symptoms. At the time of the study, he is receiving calcium carbonate (3.5 g/d) as a phosphate binder and has
received calcitriol orally intermittently for control of parathyroid hormone (PTH) levels. His physical examination is unremarkable except for a functioning arteriovenous fistula in his left arm. Laboratory.studies reveal the following: calcium, 9.4 mg/dl; PO4, 7.6 mg/dl; intact PTH, 230 pg/ml (normal 10–65 pg/ml). The EBCT study shows marked coronary and mitral valve calcification.
Explanation:
In a randomized study, Sevelamer and calcium provided equivalent control of serum phosphorus but
the median absolute calcium score on EBCT in the coronary arteries and aorta nearly doubled in the
calcium treated subjects but not in the sevelamer-treated. The median percent change in coronary
artery calcium score also was four-fold greater with calcium than with sevelamer.
REFERENCE
Chertow GM, Burke SK, Raggi P: Sevelamer attenuates the progression of coronary and aortic
calcification in hemodialysis patients. Kidney Int 62: 245-52, 2002
