Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor
To the Editor: Dr Klassen and colleagues1 reported an association between pulse pressure
and mortality among patients with end-stage renal disease (ESRD).
Although such patients often have abnormal mineral metabolism, Klassen
et al do not fully address how their measure of calcium and phosphorus is
related to mortality. In the multivariate analysis, levels of calcium, phosphorus,
and parathyroid hormone (PTH) all had negative relationships with 1-year survival.
These findings are of note since these variables have been shown to be associated
with increased risk of vascular calcification and cardiovascular mortality.2,3 Vascular calcification has been
shown to contribute to the increased arterial stiffness seen in ESRD and is
related to increased pulse wave velocity and pulse pressure.4
The finding by Klassen et al of increased cardiovascular mortality with increasing
calcium, phosphorus, and PTH levels suggests a relationship, perhaps mediated
by an osteoblastlike cell.5
Rowe IAC. Mineral Metabolism and Vascular Disease in Patients With End-Stage Renal Failure. JAMA. 2002;288(6):695-696. doi:10.1001/jama.288.6.693