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Ideal pre-HD Ca levels seem to be invalid (because serum Ca concentration tend to decline with higher serum P concentration) compared to P and Ca–P product. High levels of these parameters are well known to be associated with higher rate of vascular calcification, cardiovasucular events and death [3–5]. However, hypercalcemia is well known as one of the risk factors for vascular calcification, and several studies [6–8] have shown that the dose of calcium-based phosphate binders is associated with vascular calcification. At present, as Ix et al. describes [9], we should aim to control Ca, P and PTH within the target levels using adequate dose of oral phosphate binders and activated vitamin D derivates, in accordance with K/DOQI and Japanese guidelines [2,10], based on available scientific evidences. More studies on dialysate level, Ca/P metabolism, PTH and other hormones are needed to prevent vascular calcification in dialysis patients.

Confirming high prevalence of patients with a high risk for obstructive sleep apnoea syndrome after kidney transplantation