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. 1977 Feb;86(2):403–424.

Soft tissue calcification in chronic dialysis patients.

D C Kuzela, W E Huffer, J D Conger, S D Winter, W S Hammond
PMCID: PMC2032079  PMID: 836675

Abstract

Autopsy protocols and microscopic slides of 56 dialyzed and 18 nondialyzed chronically uremic patients were reviewed to assess the presence, extent, and severity of extraosseous soft tissue calcification. Calcification was identified in 79% of the dialysis patients and 44% of the nondialysis patients (P iss less than .025). Soft tissue calcification most frequently involved the heart, lungs, stomach, and kidneys. Lesions were severe in 36% of the dialysis patients and, when strategically located within the myocardium, were life-threatening. The deaths of 6 dialysis patients were attributed to severe calcification of the cardiac conduction system and/or myocardium. The presence and severity of soft tissue calcification was not related to duration of dialysis, patients' age, degree of parathyroid gland hyperplasia, radiographic evidence of soft tissue calcification, serum calcium and phosphate levels, Ca X P products, or type or severity of metabolic bone disease.

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Selected References

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  1. Alfrey A. C., Jenkins D., Groth C. G., Schorr W. S., Gecelter L., Ogden D. A. Resolution of hyperparathyroidism, renal osteodystrophy and metastatic calcification after renal homotransplantation. N Engl J Med. 1968 Dec 19;279(25):1349–1356. doi: 10.1056/NEJM196812192792501. [DOI] [PubMed] [Google Scholar]
  2. Alfrey A. C., Mishell J. M., Burks J., Contiguglia S. R., Rudolph H., Lewin E., Holmes J. H. Syndrome of dyspraxia and multifocal seizures associated with chronic hemodialysis. Trans Am Soc Artif Intern Organs. 1972;18(0):257-61, 266-7. doi: 10.1097/00002480-197201000-00064. [DOI] [PubMed] [Google Scholar]
  3. BARBER N. D., NAKAMOTO S., McCORMACK L. J., KOLFF W. J. Pathologic anatomy of 13 patients after prolonged periodic hemodialyses. Trans Am Soc Artif Intern Organs. 1963;9:21–28. [PubMed] [Google Scholar]
  4. Berlyne G. M. Microcrystalline conjunctival calcification in renal failure. A useful clinical sign. Lancet. 1968 Aug 17;2(7564):366–370. doi: 10.1016/s0140-6736(68)90590-4. [DOI] [PubMed] [Google Scholar]
  5. Boner G., Jacob E. T., Pevzner S., Jungmann A. Diffuse calcification of lungs in a patient on maintenance hemodialysis. Isr J Med Sci. 1971 Oct;7(10):1182–1187. [PubMed] [Google Scholar]
  6. CANER J. E., DECKER J. L. RECURRENT ACUTE (?GOUTY) ARTHRITIS IN CHRONIC RENAL FAILURE TREATED WITH PERIODIC HEMODIALYSIS. Am J Med. 1964 Apr;36:571–582. doi: 10.1016/0002-9343(64)90105-6. [DOI] [PubMed] [Google Scholar]
  7. Cadnapaphornchai P., Kuruvila K. C., Holmes J., Schrier R. W. Analysis of 5 year experience of home dialysis as a treatment modality for patients with end-stage renal failure. Am J Med. 1974 Nov;57(5):789–799. doi: 10.1016/0002-9343(74)90853-5. [DOI] [PubMed] [Google Scholar]
  8. Conger J. D., Hammond W. S., Alfrey A. C., Contiguglia S. R., Stanford R. E., Huffer W. E. Pulmonary calcification in chronic dialysis patients. Clinical and pathologic studies. Ann Intern Med. 1975 Sep;83(3):330–336. doi: 10.7326/0003-4819-83-3-330. [DOI] [PubMed] [Google Scholar]
  9. Contiguglia S. R., Alfrey A. C., Miller N. L., Runnells D. E., Le Geros R. Z. Nature of soft tissue calcification in uremia. Kidney Int. 1973 Sep;4(3):229–235. doi: 10.1038/ki.1973.104. [DOI] [PubMed] [Google Scholar]
  10. Eastwood J. B., Bordier P. J., de Wardener H. E. Some biochemical, histological, radiological and clinical features of renal osteodystrophy. Kidney Int. 1973 Aug;4(2):128–140. doi: 10.1038/ki.1973.91. [DOI] [PubMed] [Google Scholar]
  11. Friedman S. A., Rosen H. Uremia and cardiovascular mortality. Ann Intern Med. 1974 Nov;81(5):696–697. doi: 10.7326/0003-4819-81-5-696. [DOI] [PubMed] [Google Scholar]
  12. Huffer W. E., Kuzela D., Popovtzer M. M. Metabolic bone disease in chronic renal failure. I. Dialyzed uremics. Am J Pathol. 1975 Mar;78(3):365–384. [PMC free article] [PubMed] [Google Scholar]
  13. Izawa H., Imura M., Kuroda M., Takeda R. Proceedings: Effect of magnesium on secondary hyperparathyroidism in chronic hemodialysis: a case with soft tissue calcification improved by high Mg dialysate. Calcif Tissue Res. 1974;15(2):162–162. [PubMed] [Google Scholar]
  14. Johnson C., Graham C. B., Kings F., Curtis B. Roentgenographic manifestations of chronic renal disease treated by periodic hemodialysis. Am J Roentgenol Radium Ther Nucl Med. 1967 Dec;101(4):915–926. doi: 10.2214/ajr.101.4.915. [DOI] [PubMed] [Google Scholar]
  15. Kaltreider H. B., Baum G. L., Bogaty G., McCoy M. D., Tucker M. So-called "metastatic" calcification of the lung. Am J Med. 1969 Feb;46(2):188–196. doi: 10.1016/0002-9343(69)90003-5. [DOI] [PubMed] [Google Scholar]
  16. Koshy M. C., Weinstein E., Pope R. H., Boreyko C., Silverman D., Grant J. Letter: Calcific cardiomyopathy. N Engl J Med. 1975 Jan 23;292(4):209–210. doi: 10.1056/NEJM197501232920414. [DOI] [PubMed] [Google Scholar]
  17. Lange H., Gossmann H. H. Metastatic calcification during peritoneal dialysis for terminal chronic glomerulonephritis. Ger Med Mon. 1967 May;12(5):220–222. [PubMed] [Google Scholar]
  18. Lawton R. L., Gulesserian H. P., Rossi N. P. Surgical problems in patients on maintenance dialysis. Arch Surg. 1968 Aug;97(2):283–290. doi: 10.1001/archsurg.1968.01340020147018. [DOI] [PubMed] [Google Scholar]
  19. Lindner A., Charra B., Sherrard D. J., Scribner B. H. Accelerated atherosclerosis in prolonged maintenance hemodialysis. N Engl J Med. 1974 Mar 28;290(13):697–701. doi: 10.1056/NEJM197403282901301. [DOI] [PubMed] [Google Scholar]
  20. Massry S. G., Coburn J. W., Popovtzer M. M., Shinaberger J. H., Maxwell M. H., Kleeman C. R. Secondary hyperparathyroidism in chronic renal failure. The clinical spectrum in uremia, during hemodialysis, and after renal transplantation. Arch Intern Med. 1969 Oct;124(4):431–441. [PubMed] [Google Scholar]
  21. Mirahmadi K. S., Coburn J. W., Bluestone R. Calcific periarthritis and hemodialysis. JAMA. 1973 Jan 29;223(5):548–549. [PubMed] [Google Scholar]
  22. Neff M., Yalcin S., Gupta S., Berger H. Extensive metastatic calcification of the lung in an azotemic patient. Am J Med. 1974 Jan;56(1):103–109. doi: 10.1016/0002-9343(74)90755-4. [DOI] [PubMed] [Google Scholar]
  23. POLLAK V. E., SCHNEIDER A. F., FREUND G., KARK R. M. Chronic renal disease with secondary hyperparathyroidism. AMA Arch Intern Med. 1959 Feb;103(2):200–218. doi: 10.1001/archinte.1959.00270020028004. [DOI] [PubMed] [Google Scholar]
  24. Parfitt A. M., Massry S. G., Winfield A. C., DePalma J. R., Gordon A. Disordered calcium and phosphorus metabolism during maintenance hemodialysis. Correlation of clinical, roentgenographic and biochemical changes. Am J Med. 1971 Sep;51(3):319–330. doi: 10.1016/0002-9343(71)90267-1. [DOI] [PubMed] [Google Scholar]
  25. Parfitt A. M. Soft-tissue calcification in uremia. Arch Intern Med. 1969 Nov;124(5):544–556. [PubMed] [Google Scholar]
  26. Savoy G. M., Yium J. J., Jordan P. H., Jr, Guinn G. A. Hyperparathyroidism in patients on chronic hemodialysis. Am J Surg. 1973 Dec;126(6):755–757. doi: 10.1016/s0002-9610(73)80064-9. [DOI] [PubMed] [Google Scholar]
  27. Terman D. S., Alfrey A. C., Hammond W. S., Donndelinger T., Ogden D. A., Holmes J. H. Cardiac calcification in uremia. A clinical, biochemical and pathologic study. Am J Med. 1971 Jun;50(6):744–755. doi: 10.1016/0002-9343(71)90182-3. [DOI] [PubMed] [Google Scholar]
  28. Varghese Z., Moorhead J. F., Wills M. R. Plasma calcium and magnesium fractions in chronic-renal-failure patients on maintenance haemodialysis. Lancet. 1973 Nov 3;302(7836):985–988. doi: 10.1016/s0140-6736(73)91087-8. [DOI] [PubMed] [Google Scholar]
  29. Verberckmoes R., Bouillon R., Krempien B. Disappearance of vascular calcifications during treatment of renal osteodystrophy. Two patients treated with high doses of vitamin D and aluminum hydroxide. Ann Intern Med. 1975 Apr;82(4):529–533. doi: 10.7326/0003-4819-82-4-529. [DOI] [PubMed] [Google Scholar]
  30. Wing A. J. Calcium metabolism and maintenance hemodialysis. Am Heart J. 1969 Dec;78(6):836–838. doi: 10.1016/0002-8703(69)90454-2. [DOI] [PubMed] [Google Scholar]
  31. Wing A. J. Optimum calcium concentration of dialysis fluid for maintenance haemodialysis. Br Med J. 1968 Oct 19;4(5624):145–149. doi: 10.1136/bmj.4.5624.145. [DOI] [PMC free article] [PubMed] [Google Scholar]

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