Cardiovascular calcifications in chronic kidney disease: Potential therapeutic implications.
Cardiovascular (CV) calcification is a highly prevalent condition at all stages of chronic kidney disease (CKD) and is directly associated with increased CV and global morbidity and mortality. In the first part of this review, we have shown that CV calcifications represent an important part of the CKD-MBD complex and are a superior predictor of clinical outcomes in our patients. However, it is also necessary to demonstrate that CV calcification is a modifiable risk factor including the possibility of decreasing (or at least not aggravating) its progression with iatrogenic manoeuvres. Although, strictly speaking, only circumstantial evidence is available, it is known that certain drugs may modify the progression of CV calcifications, even though a direct causal link with improved survival has not been demonstrated. For example, non-calcium-based phosphate binders demonstrated the ability to attenuate the progression of CV calcification compared with the liberal use of calcium-based phosphate binders in several randomised clinical trials. Moreover, although only in experimental conditions, selective activators of the vitamin D receptor seem to have a wider therapeutic margin against CV calcification. Finally, calcimimetics seem to attenuate the progression of CV calcification in dialysis patients. While new therapeutic strategies are being developed (i.e. vitamin K, SNF472, etc.), we suggest that the evaluation of CV calcifications could be a diagnostic tool used by nephrologists to personalise their therapeutic decisions.
Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, RedinRen, Barcelona, España. Electronic address: jbover@fundacio-puigvert.es.
Jordi
J
Bover
Departamento de Nefrología y Diálisis, Clinique du Landy, París, Francia; Departamento de Fisiología Renal, Hospital Necker, Universidad de París Descartes, París, Francia.
Pablo
P
Ureña-Torres
Servicio de Nefrología, Hospital Universitario Dr. Peset, Valencia, España.
José Luis
JL
Górriz
Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, RedinRen, Barcelona, España.
María Jesús
MJ
Lloret
Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, RedinRen, Barcelona, España.
Iara
I
da Silva
Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, RedinRen, Barcelona, España.
César
C
Ruiz-García
Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, RedinRen, Barcelona, España.
Pamela
P
Chang
Servicio de Nefrología, Hospital Universitario Reina Sofía, IMIBIC, Universidad de Córdoba, Córdoba, España.
Mariano
M
Rodríguez
Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, RedinRen, Barcelona, España.
José
J
Ballarín
D057966:Calcimimetic Agents / Q000627:therapeutic use; D002908:Chronic Disease; D012080:Chronic Kidney Disease-Mineral and Bone Disorder; D018450:Disease Progression; D006801:Humans; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D061205:Vascular Calcification / Q000175:diagnosis* / Q000188:drug therapy*
D057966:Calcimimetic Agents
Calcificación vascular; Calcifilaxis; Calcimimetics; Calcimiméticos; Calciphylaxis; Chronic kidney disease; Chronic kidney disease-mineral and bone disorders; Enfermedad renal crónica; Fosfato; Phosphate; Vascular calcification; Vitamin D; Vitamina D