**Part 3**

**Complications**

312 Progress in Hemodialysis – From Emergent Biotechnology to Clinical Practice

Zimmermann, J., Herrlinger, S., Pruy, A., Metzger, T., & Wanner, C. (1999). Inflammation

*International, 55*(2), 648-658.

enhances cardiovascular risk and mortality in hemodialysis patients. *Kidney* 

**17** 

*Japan* 

and Yutaka Taketani

*University of Tokushima Graduate School* 

**Complications and Managements of** 

Eiji Takeda, Hironori Yamamoto, Hisami Yamanaka-Okumura

Dialysis patients have extraordinarily high mortality rates. Cardiac disease is the major cause of death accounting for 43% of all-cause mortality among patients receiving hemodialysis and peritoneal dialysis [Henry et al., 2002; US Renal Data System Annual Data Report Bethesta, 2005]. In previous report, patients with end-stage kidney disease (chronic kidney disease (CKD) stage 5) on dialysis, in comparison with the general population, also have a 3- to 30-fold increase in mortality, depending on the age group examined, and cardiovascular disease accounts for more than half of all deaths, with myocardial infarction, ischaemic cardiomyopathy, stroke and peripheral vascular disease making up the bulk of deaths (Foley et al., 1998). The marked excess in cardiovascular mortality in CKD, compared with the general population, is not explained by the presence of traditional Framingham risk factors, such as diabetes, smoking, hypertension and elevated cholesterol levels ( Zoccali, 2000; Longenecker et al., 2002). With vascular calcification and arterial stiffness being observed in young and middle-aged dialysis patients without conventional cardiovascular risk factors (London et al., 2003), the search for non-traditional risk factors has led to increasing evidence of a multitude of factors that contribute to ectopic calcification in CKD.

Inorganic phosphate (phosphate) retention, or hyperphosphatemia, has been identified as playing a major role in the progression of renal failure and in the generation of secondary hyperparathyroidism and uremic bone disease (Slatopolsky et al., 2002). Further observational data have also shown a significant association of hyperphosphatemia with increased mortality among patients who have end-stage kidney disease and are on hemodialysis (Block et al., 1998; Owen & Lowrie, 1998; Ganesh et al., 2001). Moreover, elevated serum phosphorus has been associated with an increased risk for cardiovascular mortality and hospitalization (all-cause, cardiovascular, and fracture) among dialysis patients (Block et al., 2004). Elevated phosphorus and Ca × P are also independent risk factors for all-cause and cardiovascular mortality in CKD stage 5, and increased levels of parathyroid hormone may be associated with both cardiovascular disease and increased

**1. Introduction** 

**1.1 High mortality in dialysis patients** 

**1.2 High mortality rate and hyperphosphatemia** 

**Hyperphosphatemia in Dialysis** 
