Maintenance Hemodialysis-Reply

In Reply.— Whether or not hypertension and an elevated calcium-phosphate product are truly independent risk factors for cardiovascular disease in hemodialysis patients is a point fairly made. It is apparent that patients who are hypertensive are also more likely to have an elevated calcium-phosphate product, because they are noncompliant. That these factors are otherwise connected is unlikely. Even if hypertension in azotemic patients is controlled by drug therapy, failure to take unpalatable and constipating phosphate binders could still permit a sustained elevated product and metastatic calcification. When present together in the same patient, the negative effect on the cardiovascular system may be synergistic. Related to hypertension or not, an elevated calcium-phosphate product is certainly abnormal, and the lack of any statistical correlation with pathological damage should not preempt vigorous attempts at controlling this abnormality or any others when nontoxic therapy is available. Nephrologists are aware that the control of these