Vascular calcification: pathogenesis, epidemiology anda clinical impact

Abstract

Several studies suggest that vascular calcifications play a main role in the cardiovascular disease, which is one of the main causes of mortality in CKD patients. Vascular calcification is determined by prevalent traditional, uraemia-related and non-traditional risk factors such as cardiovascular disease or pro-inflammatory molecules and occurs mainly in the arteries, which are classified in three types according to their size and structural characteristics. Several epidemiological studies have linked vascular calcifications to bone loss and fractures in chronic kidney disease patients and also in the general population, stressing the fact that both can share pathogenetic pathways. The mechanisms behind vascular calcification are complex and not yet fully understood. Phosphorus plays a main role, while other elements related to bone formation have been recently identified, including the BMP-Wnt-Msx-2 axis. The strategies to control vascular calcifications involve several measures, chief among them the control of hyperphosphatemia. Furthermore, it has been recently described that strategies focusing on both reducing bone resorption and increasing bone mineralization may decrease the risk of vascular calcifications.