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Review
. 2016 Sep 6;5(5):398-417.
doi: 10.5527/wjn.v5.i5.398.

Vascular calcification: When should we interfere in chronic kidney disease patients and how?

Usama Abdel Azim Sharaf El Din  1 , Mona Mansour Salem  1 , Dina Ossama Abdulazim  1
Affiliations
Review

Vascular calcification: When should we interfere in chronic kidney disease patients and how?

Usama Abdel Azim Sharaf El Din et al. World J Nephrol. .

Abstract

Chronic kidney disease (CKD) patients are endangered with the highest mortality rate compared to other chronic diseases. Cardiovascular events account for up to 60% of the fatalities. Cardiovascular calcifications affect most of the CKD patients. Most of this calcification is related to disturbed renal phosphate handling. Fibroblast growth factor 23 and klotho deficiency were incriminated in the pathogenesis of vascular calcification through different mechanisms including their effects on endothelium and arterial wall smooth muscle cells. In addition, deficient klotho gene expression, a constant feature of CKD, promotes vascular pathology and shares in progression of the CKD. The role of gut in the etio-pathogenesis of systemic inflammation and vascular calcification is a newly discovered mechanism. This review will cover the medical history, prevalence, pathogenesis, clinical relevance, different tools used to diagnose, the ideal timing to prevent or to withhold the progression of vascular calcification and the different medications and medical procedures that can help to prolong the survival of CKD patients.

Keywords: Calcific uremic arteriolopathy; Calcification; Chronic kidney disease; Fibroblast growth factor 23; Kidney transplantation; Klotho; Phosphate binders; Sevelamer; Uremia.

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Figures

Figure 1
Figure 1
Male patient, 36-year-old, on regular hemodialysis for 8 years, presenting with multiple skin ulcers affecting both legs. A: His corrected serum calcium is 10.28 mg/dL and serum phosphorus 8 mg/dL. Serum PTH is 2588 pg/mL. He initially experienced itching papules that eventually ulcerated; B: Another ulcer with necrotic floor in the same patient. PTH: Parathyroid hormone.
Figure 2
Figure 2
Plain X-ray of the pelvis in hemodialysis patient for 52 mo showing extensive calcification of the right common and external iliac arteries (arrows).
Figure 3
Figure 3
Doppler study of popliteal artery, the vessel wall shows linear calcification.
See this image and copyright information in PMC

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