title: Vascular calcification in chronic kidney disease: are biomarkers useful for probing the pathobiology and the health risks of this process in the clinical scenario?
abstract: Patients with chronic kidney disease (CKD) are at a particularly high risk for cardiovascular disease. Vascular calcification (VC) is considered a cardiovascular risk marker, so in CKD patients screening for the presence of VC is suggested in current guidelines. VC is the result of both passive and active processes that involve a variety of proteins and factors. In the CKD population, numerous studies have identified circulating biomarkers potentially responsible for VC and have evaluated their link with this process. This narrative review, and an accompanying analysis performed on the Amiens CKD database, focuses on selected VC biomarkers-namely phosphate, fibroblast growth factor 23 (FGF23), osteopontin (OPN), osteoprotegerin (OPG), matrix Gla protein and fetuin A-all of which have been implicated as major players in VC in experimental studies in vitro or in animal models. None of the VC biomarkers considered in this review have qualified as a reliable predictor of meaningful clinical events or as a valid indicator of the risk of having VC. In the analysis based on the Amiens-CKD database, no biomarker outperformed age and the classical risk factors as a predictor of VC either in the aorta or in the coronaries. Well-designed clinical trials are now urgently needed to test the potential value of these biomarkers as a guide for interventions targeting VC.
authors.affiliation: INSERM, U 1088, and Jules Verne University of Picardie, Amiens, France Division of Clinical Pharmacology, Clinical Research Centre, Amiens University Medical Center, Amiens, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Liabeuf
authors.affiliation: INSERM, U 1088, and Jules Verne University of Picardie, Amiens, France.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Okazaki
authors.affiliation: INSERM, U 1088, and Jules Verne University of Picardie, Amiens, France Division of Clinical Pharmacology, Clinical Research Centre, Amiens University Medical Center, Amiens, France.
authors.forename: Lucie
authors.initials: L
authors.lastname: Desjardins
authors.affiliation: Department of Internal Medicine IV, Saarland University Medical Centre, Homburg/Saar, Germany.
authors.forename: Danilo
authors.initials: D
authors.lastname: Fliser
authors.affiliation: Renal Unit, Guy's and St Thomas' NHS Foundation Hospital, King's Health Partners, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Goldsmith
authors.affiliation: Clinic of Nephrology, University of Medicine 'Gr. T. Popa' Iasi and Hospital 'C. I. Parhon' Iasi, Iasi, Romania.
authors.forename: Adrian
authors.initials: A
authors.lastname: Covic
authors.affiliation: Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia in Katowice, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Wiecek
authors.affiliation: IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo, Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Ortiz
authors.affiliation: Hospital Universitario de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Martinez-Castelao
authors.affiliation: Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindholm
authors.affiliation: Nephrology Division, Department of Medicine, Akdeniz University Medical School, Antalya, Turkey.
authors.forename: Gultekin
authors.initials: G
authors.lastname: Suleymanlar
authors.affiliation: Nephrology, Dialysis and Transplantation Unit and CNR-IBIM Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Cal, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Mallamaci
authors.affiliation: Nephrology, Dialysis and Transplantation Unit and CNR-IBIM Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Cal, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
authors.affiliation: INSERM U970, Hopital Européen Georges Pompidou, Paris, France.
authors.forename: Gerard
authors.initials: G
authors.lastname: London
authors.affiliation: INSERM, U 1088, and Jules Verne University of Picardie, Amiens, France Division of Nephrology, Ambroise Paré Hospital, Paris-Boulogne Billancourt, France.
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Massy
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000378:metabolism*; D000089703:Fibroblast Growth Factor-23; D006801:Humans; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000378:metabolism* / Q000473:pathology; D012307:Risk Factors; D061205:Vascular Calcification / Q000209:etiology* / Q000378:metabolism / Q000473:pathology
chemical_list: D015415:Biomarkers; C000717427:FGF23 protein, human; D000089703:Fibroblast Growth Factor-23
keywords: biomarkers; chronic kidney disease; vascular calcification