Stones and Bones

Stones and Bones

Arterial calcification is a common problem in advanced kidney disease and contributes to the high prevalence of cardiovascular disease. There are two forms: neointimal calcification, associated with atherosclerosis, and medial calcification. The former is not exclusive to renal failure and occurs in anyone with atherosclerosis. It is unclear whether this has any clinical significance other than being a convenient marker of atherosclerosis. Medial calcification is independent of atherosclerosis and is strongly linked with chronic kidney disease (CKD).

Phosphate is a true uremic toxin. Cross-sectional studies in patients undergoing dialysis uniformly demonstrate an increased risk of mortality with increasing phosphate levels. The population-attributable risk of mortality in dialysis patients is markedly greater for phosphate than anemia or urea reduction ratio.

Of longstanding interest to nephrologists, vitamin D has now become a hot topic in the general medical and lay literature. While the beneficial effects of vitamin D on mineral metabolism have been appreciated for a century, a burgeoning body of literature attests to a multitude of other effects including modulation of the immune system, anti-infectious and anti-neoplastic effects, anti-proteinuric effects, antagonism of the renin angiotensin system with attendant cardiovascular benefits, and insulin-sensitizing effects.

One might think that rare diseases are rare. But if one were to combine all the rare diseases that affect Americans, the overall prevalence is not rare at all. In fact, 30 million Americans, or roughly 10 percent of the population, are affected by a rare disease. Many of these disorders are severe and lead to a significant effect on people’s lives and life expectancy.