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Titolo Phosphate restriction significantly reduces mortality in uremic rats with established vascular calcification
Autore Jane L. Finch1, Duk H. Lee2, Helen Liapis1,3, Cindy Ritter1, Sarah Zhang1, Edu Suarez4,5, Leon Ferder4 and Eduardo Slatopolsky1 - 1Renal Division, Washington University School of Medicine, St Louis, Missouri, USA; 2Division of Nephrology, Daegu Fatima Hospital, Daegu, South Korea; 3Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri, USA; 4Department of Physiology and Pharmacology, Ponce School of Medicine, Ponce, Puerto Rico and 5Department of Biology, Porce School of Medicine, Ponce, Puerto Rico
Referenza Kidney International 2013; 84: 1145–1153
Contenuto

The role of hyperphosphatemia in the pathogenesis of secondary hyperparathyroidism, cardiovascular disease, and progression of renal failure is widely known. Here we studied effects of dietary phosphate restriction on mortality and vascular calcification in uremic rats. Control and uremic rats were fed a high-phosphate diet and at 3 months a portion of rats of each group were killed. Serum phosphate and the calcium phosphate product increased in uremic rats, as did aortic calcium. Of the rats, 56% had positive aortic staining for calcium (von Kossa), RUNX2, and osteopontin. The remaining uremic rats were continued on diets containing high phosphate without and with sevelamer, or low phosphate, and after 3 more months they were killed. Serum phosphate was highest in uremic rats on high phosphate. Serum PTH and FGF-23 were markedly lower in rats on low phosphate. Mortality on high phosphate was 71.4%, with sevelamer reducing this to 37.5% and phosphate restriction to 5.9%. Positive aortic staining for von Kossa, RUNX2, and osteopontin was increased, but phosphate restriction inhibited this. Kidneys from low-phosphate and sevelamer-treated uremic rats had less interstitial fibrosis, glomerulosclerosis, and inflammation than those of uremic rats on high phosphate. Importantly, kidneys from rats on low phosphate showed improvement over kidneys from high-phosphate rats at 3 months. Left ventricles from rats on low phosphate had less perivascular fibrosis and smaller cardiomyocyte size compared to rats on high phosphate. Thus, intensive phosphate restriction significantly reduces mortality in uremic rats with severe vascular calcification.

Data 17.07.2014
 
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