Bone and Vascular Health and the Kidney

Abstract

In patients with progressive chronic kidney disease (CKD), the homeostatic mechanisms regulating calcium and phosphate metabolism suffer important changes resulting in low serum levels of calcitriol and calcium and phosphorous retention. The regulatory mechanisms fail and several chronic kidney disease mineral bone disorders (CKD-MBD) occur, including bone disease, vascular calcifications, cardiovascular disorders, bone fragility fractures and reduced survival. Vascular calcification, bone loss and increased fracture risk are severe disorders associated with ageing in chronic CKD, but also generally speaking. Several epidemiological studies have shown the relationship between impaired bone metabolism, vascular calcification and increased mortality. Recent data suggest this association may be not just a consequence of ageing; the common occurrence of severe cases of vascular calcifications together with low bone activity and osteoporosis suggests there might be some direct biological links between the bone and the vascular systems. New challenging experimental data suggest that once the severe vascular calcification appears, vessels may develop a mechanism to diminish the vascular mineralization in the artery wall, this defensive mechanism may have a negative impact favouring the reduction of bone mass.