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Review
. 2019 Apr 9;11(4):213.
doi: 10.3390/toxins11040213.

The Key Role of Phosphate on Vascular Calcification

Mario Cozzolino  1 , Paola Ciceri  2 , Andrea Galassi  3 , Michela Mangano  4 , Stefano Carugo  5 , Irene Capelli  6 , Giuseppe Cianciolo  7
Affiliations
Review

The Key Role of Phosphate on Vascular Calcification

Mario Cozzolino et al. Toxins (Basel). .

Abstract

Vascular calcification (VC) is common in dialysis and non-dialysis chronic kidney disease (CKD) patients, even in the early stage of the disease. For this reason, it can be considered a CKD hallmark. VC contributes to cardiovascular disease (CVD) and increased mortality among CKD patients, although it has not been proven. There are more than one type of VC and every form represents a marker of systemic vascular disease and is associated with a higher prevalence of CVD in CKD patients, as shown by several clinical studies. Major risk factors for VC in CKD include: Increasing age, dialysis vintage, hyperphosphatemia (particularly in the setting of intermittent or persistent hypercalcemia), and a positive net calcium and phosphate balance. Excessive oral calcium intake, including calcium-containing phosphate binders, increases the risk for VC. Moreover, it has been demonstrated that there is less VC progression with non-calcium-containing phosphate binders. Unfortunately, until now, a specific therapy to prevent progression or to facilitate regression of VC has been found, beyond careful attention to calcium and phosphate balance.

Keywords: chronic kidney disease; hyperphosphatemia; phosphate binder; secondary hyperparathyroidism; vascular calcification.

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Conflict of interest statement

The authors declare no conflict of interest. This article was written on behalf of CKD-MBD WG, which is an official body of the ERA-EDTA (European Renal Association—European Dialysis and Transplant Association)

Figures

Figure 1
Figure 1
Schematic representation of intimal and medial calcification. LVH: Left ventricular hypertrophy; VSMC: Vascular smooth muscle cells.
Figure 2
Figure 2
Major regulators and effects of P on vascular calcification. Ca: calcium; FGF-23: fibroblast growth factor-23; P: phosphate; VSMC: vascular smooth muscle cells.
See this image and copyright information in PMC

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