Abstract
Cardiovascular disease remains the leading cause of increased morbidity and mortality in patients with chronic kidney disease and is attributed to early and accelerated atherosclerosis and arteriosclerosis observed in this patient population. Vascular calcifications, particularly of the media, are commonly found in chronic uremia and are a major contributor to arteriosclerosis and increased arterial stiffness. Epidemiologic data support the correlation of vascular calcification and arterial stiffness to adverse cardiovascular outcomes and mortality. Experimental evidence has shed light on the pathogenetic mechanisms of vascular calcification and arterial stiffness and their relation to impaired bone metabolism and imbalance between promoters and inhibitors of extra-osseous bone formation. However further research is needed to clarify their exact contribution and whether their targeting could significantly affect vascular calcification and arterial stiffening and could improve survival in chronic kidney disease patients.
Highlights
Cardiovascular disease (CVD) remains the leading cause of increased morbidity and mortality in patients with chronic kidney disease (CKD) and those on renal replacement therapy [1, 2]
The pathogenesis of vasculopathy in CKD involves traditional risk factors of atherosclerosis, which are highly prevalent in renal patients, and several non-traditional or uremia-related risk factors, which are intensively investigated
Vascular calcifications, of the media, are an almost ubiquitous feature of arterial tree in chronic uremia and a major contributor to accelerated arteriosclerosis and increased arterial stiffness observed in CKD patients [3,4,5]
Summary
Cardiovascular disease (CVD) remains the leading cause of increased morbidity and mortality in patients with chronic kidney disease (CKD) and those on renal replacement therapy [1, 2]. The extent of vascular calcification and the degree of arterial stiffness, closely interrelated, are non-traditional CVD risk factors and independent predictors of CVD mortality, both in general population and CKD patients [6,7,8,9,10]. Several studies have shown that mineral-bone disorders and imbalance between promoters and inhibitors of extra-osseous bone formation are associated with vascular calcification and affect significantly the process of arterial stiffening in renal population, potentially leading to adverse clinical outcomes [5, 11].
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