The Effects of Vitamin D Therapy on Left Ventricular Structure and Function - Are These the Underlying Explanations for Improved CKD Patient Survival?

被引:33
作者
Covic, Adrian [2 ]
Voroneanu, Luminita [2 ]
Goldsmith, David [1 ]
机构
[1] Kings Hlth Partners, London, England
[2] Gr T Popa Univ Med & Pharm, Nephrol Clin, Parhon Univ Hosp, Iasi, Romania
来源
NEPHRON CLINICAL PRACTICE | 2010年 / 116卷 / 03期
关键词
Chronic kidney disease; Vitamin D deficiency; Cardiac function; PULSE-WAVE VELOCITY; PARATHYROID-HORMONE; HEMODIALYSIS-PATIENTS; BLOOD-PRESSURE; D-RECEPTOR; PRIMARY HYPERPARATHYROIDISM; 1,25-DIHYDROXYVITAMIN D-3; VASCULAR CALCIFICATION; CARDIAC ABNORMALITIES; CELL-PROLIFERATION;
D O I
10.1159/000317198
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Cardiovascular disease is a major cause of death among patients with chronic kidney disease and vitamin D deficiency is a common problem also among these patients. Abnormalities in left ventricular size and function are frequent, as they are encountered in 70-80% of incident dialysis patients. These alterations develop early in the course of renal disease and their prevalence progresses in parallel with the decline in renal function. This process of left ventricular dilatation with compensatory hypertrophy continues after the institution of dialysis therapy, especially in the first year. The main factors responsible for the progression of left ventricular hypertrophy (LVH) are considered to be blood pressure and anemia, and in patients receiving hemodialysis, the arteriovenous fistula, volume overload and abnormalities in mineral metabolism. This additional potential set of factors related to LVH - mineral and bone metabolism - is intriguing and begs an immediate question: by what possible mechanism can these factors be linked to cardiac morphology? Recent observational studies have indeed indicated that vitamin D treatment was associated with a significant reduction of cardiovascular death among dialysis patients, and a reduction in LVH; in contrast, other studies suggested that excess vitamin D contributes to risk of hypercalcemia and vascular calcification, which is associated with reduced survival and morbidity. This review examines the evidence linking vitamin D with cardiac structure and function. Copyright (C) 2010 S. Karger AG, Basel
引用
收藏
页码:C187 / C195
页数:9
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