Cardiovascular complications as a consequence of secondary hyperparathyroidism in patients with chronic kidney disease

Abstract

Almost half of deaths in patients with chronic kidney disease (CKD) are caused by cardiovascular complications. The risk of death and cardiovascular events increases already at estimated glomerular filtration rate below 60 ml//min/1.73 m². In patients with CKD stage 2–4t here is a greater probability of death (from cardiovascular causes) than of progression to end-stage renal disease. Mortality risk for hemodialysed patients with CKD is approximately 500 times higher in younger patients (age 30) to approximately 4 times (age 80) higher compared to patients without a kidney disease. Calcium-phosphate disorders (hypocalcemia, hyperphosphatemia, low active vitamine D level) develop in patients with CKD and are associated with a decrease in serum concentrations of Klotho and fibroblast growth factor 23 as well as development of secondary hyperparathyroidism. Hyperparathyroidismparticipates in the pathogenesis ofcardiovascular complications in patients withCKD such as: atherosclerosis, arterial calcification,hypertension, cardiac arrhythmias,ischemic heart disease, left ventricular hypertrophyand heart failure. A successful treatmentof hyperparathyroidism has been thought to reducethe cardiovascular risk in CKD patients.However the recently published results of theEVOLVE trial, did not confirm reduction of cardiovascularrisk in CKD patients treated for hyperparathyroidismwith a calcimimetic.