Cardiovascular disease occurs in
ESRD patients at rates that are far higher than is seen in the general population, and cardiovascular deaths account for the majority of deaths among dialysis patients. Abnormal
mineral metabolism is a novel cardiovascular risk factor among dialysis patients. Recently published results demonstrated that even with good control of BP and
anemia, conventional
hemodialysis is associated with significant
left ventricular hypertrophy (LVH); however, daily
hemodialysis was associated with a significant reduction in LV mass index (LVMI). Furthermore, it was shown that control of serum
phosphorus correlates with the reduction in LVMI. These data suggest a novel mechanism for the deleterious effect of elevated serum
phosphorus on cardiovascular outcomes among
hemodialysis patients: LVH. Other investigators have noted an association of
hyperphosphatemia and LVH; however, this study was the first to demonstrate that improvement in serum
phosphorus is associated with reduction in LVM. In addition, it is shown that daily
hemodialysis is an effective modality in improving serum
phosphorus through significantly improved
phosphorus removal. Elevated serum
phosphorus leads to
vascular calcification, which can lead to LVH by decreasing vascular compliance. However, our study showed an improvement in LVMI during a 12-mo period. Because
vascular calcification is unlikely to remit over this time period, it is proposed that serum
phosphorus has a reversible, cardiotoxic effect that leads to LVH that can be reversed successfully with good control of serum
phosphorus.