[Pathogenesis and treatment of vascular calcification in CKD].
Increased vascular calcification is a major cause of cardiovascular events in patients with chronic kidney disease (CKD). It is the result of an active ossification process counteracted by ''bone'' proteins such as osteopontin, alkaline phosphatase, osteoprotegerin, and osteocalcin. Chronic kidney disease - mineral and bone disorder (CKD-MBD) is a systemic disorder of mineral and bone metabolism that occurs in CKD. In addition to abnormalities in the serum calcium and phosphate profile, CKD-MBD is characterized by abnormalities of bone turnover, mineralization, volume and growth as well as vascular calcification. Considering that the presence and extent of vascular calcification in CKD portend a poor prognosis, many efforts have been made to shed light on this complicated phenomenon to prevent vascular calcium deposition and its progression. Indeed, careful control of calcium load, serum phosphate and parathyroid hormone along with the use of calcium-free phosphate binders and vitamin D receptor activators represent a new therapeutic armamentarium to improve quality of life and reduce mortality in CKD.
Brancaccio
D
D
Cattedra di Nefrologia, U.O. Nefrologia e Dialisi, A.O. San Paolo, Milano 20142, Italy. diego.brancaccio@unimi.it
Gallieni
M
M
Pasho
S
S
Fallabrino
G
G
Olivi
L
L
Volpi
E
E
Ciceri
P
P
Missaglia
E
E
Ronga
C
C
Brambilla
C
C
Butti
A
A
Rocca-Rey
L
L
Chiarelli
G
G
Cozzolino
M
M
D015415:Biomarkers / Q000097:blood; D002114:Calcinosis / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism* / Q000473:pathology; D002118:Calcium / Q000097:blood; D002614:Chelating Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003324:Coronary Artery Disease / Q000378:metabolism; D018450:Disease Progression; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism* / Q000473:pathology; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011788:Quality of Life; D051436:Renal Insufficiency, Chronic / Q000378:metabolism; D014652:Vascular Diseases / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism* / Q000473:pathology; D014807:Vitamin D / Q000627:therapeutic use
D015415:Biomarkers; D002614:Chelating Agents; D010281:Parathyroid Hormone; D010710:Phosphates; D014807:Vitamin D; D002118:Calcium