title: Pro: cardiovascular calcifications are clinically relevant.
abstract: It is increasingly acknowledged that mineral and bone disorders (MBDs) contribute to the excessively high cardiovascular (CV) disease morbidity and mortality observed in patients with chronic kidney disease (CKD). There is ongoing debate as to whether screening for CV calcification, one of the hallmarks of CKD-MBD, should be implemented in clinical practice in patients with CKD. Issues to be considered in this controversy relate to prevalence, severity, relevance, and last but not least, modifiability and reversibility of vascular and valvular calcifications in the setting of CKD. The recent expansion of the armamentarium to treat CKD-MBD (calcium-free phosphate binders and calcimimetics) creates new opportunities. Mounting experimental and clinical evidence indicates that progression of CV calcification may indeed be attenuated. Whether this will translate into better outcomes remains to be proven. We acknowledge that hard outcome data so far are limited and, overall, yielded inconclusive results. Nevertheless, in an era in which personalized medicine has gained much popularity, we consider it reasonable, awaiting the results of additional studies, to screen for CV calcification in selected individuals. This policy may help to stratify CV risk and to guide therapy. We speculate that such an approach will ultimately improve outcomes and reduce health costs.
authors.affiliation: Fundació Puigvert, Department of Nephrology, IIB Sant Pau, RedinRen, Barcelona, Catalonia, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Bover
authors.affiliation: Department of Nephrology and Renal Transplantation, University Hospitals, Leuven, Belgium.
authors.forename: Pieter
authors.initials: P
authors.lastname: Evenepoel
authors.affiliation: Department of Nephrology and Dialysis, Clinique du Landy, Saint-Ouen, France Department of Renal Physiology, Necker Hospital, University of Paris Descartes, Paris, France.
authors.forename: Pablo
authors.initials: P
authors.lastname: Ureña-Torres
authors.affiliation: Department of Nephrology and Institute for Cardiovascular Research VU (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Vervloet
authors.affiliation: Department of Cardiology and Intensive Care Medicine, RWTH University Hospital Aachen, Aachen, Germany.
authors.forename: Vincent
authors.initials: V
authors.lastname: Brandenburg
authors.affiliation: Department of Cardiovascular, Respiratory, Nephrologic and Geriatric Sciences, Sapienza University of Rome, Rome, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Mazzaferro
authors.affiliation: Clinic of Nephrology, C.I. Parhon University Hospital, Gr. T. Popa, University of Medicine and Pharmacy, Iasi, Romania.
authors.forename: Adrian
authors.initials: A
authors.lastname: Covic
authors.affiliation: King's Health Partners AHSC London, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Goldsmith
authors.affiliation: Division of Nephrology, Ambroise Paré Hospital, Paris Ile de France Ouest University, Paris, France INSERM U1088, Picardie University Jules Verne, Amiens, France.
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Massy
authors.affiliation: Department of Health Sciences, Renal Division and Laboratory of Experimental Nephrology, San Paolo Hospital, University of Milan, Milan, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Cozzolino
mesh_terms: D001847:Bone Diseases / Q000503:physiopathology*; D002114:Calcinosis / Q000150:complications*; D002318:Cardiovascular Diseases / Q000209:etiology*; D018450:Disease Progression; D006801:Humans; D008903:Minerals / Q000378:metabolism*; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology*
chemical_list: D008903:Minerals
keywords: chronic kidney disease; dialysis; hyperphosphataemia; vascular calcification