Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May;33(5):1011-1032.
doi: 10.1681/ASN.2021101327. Epub 2022 Mar 1.

Interventions To Attenuate Vascular Calcification Progression in Chronic Kidney Disease: A Systematic Review of Clinical Trials

Chelsea Xu  1 , Edward R Smith  1   2 , Mark K Tiong  1   2 , Irene Ruderman  1   2 , Nigel D Toussaint  1   2
Affiliations

Interventions To Attenuate Vascular Calcification Progression in Chronic Kidney Disease: A Systematic Review of Clinical Trials

Chelsea Xu et al. J Am Soc Nephrol. 2022 May.

Abstract

Background: Vascular calcification is associated with cardiovascular morbidity and mortality in people with CKD. Evidence-based interventions that may attenuate its progression in CKD remain uncertain.

Methods: We conducted a systematic review of prospective clinical trials of interventions to attenuate vascular calcification in people with CKD, compared with placebo, another comparator, or standard of care. We included prospective clinical trials (randomized and nonrandomized) involving participants with stage 3-5D CKD or kidney transplant recipients; the outcome was vascular calcification measured using radiologic methods. Quality of evidence was determined by the Cochrane risk of bias assessment tool and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method.

Results: There were 77 trials (63 randomized) involving 6898 participants eligible for inclusion (median sample size, 50; median duration, 12 months); 58 involved participants on dialysis, 15 involved individuals with nondialysis CKD, and 4 involved kidney transplant recipients. Risk of bias was moderate over all. Trials involving magnesium and sodium thiosulfate consistently showed attenuation of vascular calcification. Trials involving intestinal phosphate binders, alterations in dialysate calcium concentration, vitamin K therapy, calcimimetics, and antiresorptive agents had conflicting or inconclusive outcomes. Trials involving vitamin D therapy and HMG-CoA reductase inhibitors did not demonstrate attenuation of vascular calcification. Mixed results were reported for single studies of exercise, vitamin E-coated or high-flux hemodialysis membranes, interdialytic sodium bicarbonate, SNF472, spironolactone, sotatercept, nicotinamide, and oral activated charcoal.

Conclusions: Currently, there are insufficient or conflicting data regarding interventions evaluated in clinical trials for mitigation of vascular calcification in people with CKD. Therapy involving magnesium or sodium thiosulfate appears most promising, but evaluable studies were small and of short duration.

Keywords: CKD-MBD; cardiovascular disease; phosphate binders; vascular calcification.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
PRISMA flow diagram.
See this image and copyright information in PMC

References

    1. Braun J, Oldendorf M, Moshage W, Heidler R, Zeitler E, Luft FC: Electron beam computed tomography in the evaluation of cardiac calcification in chronic dialysis patients. Am J Kidney Dis 27: 394–401, 1996 - PubMed
    1. Banks LM, Lees B, MacSweeney JE, Stevenson JC: Effect of degenerative spinal and aortic calcification on bone density measurements in post-menopausal women: Links between osteoporosis and cardiovascular disease? Eur J Clin Invest 24: 813–817, 1994 - PubMed
    1. Rix M, Andreassen H, Eskildsen P, Langdahl B, Olgaard K: Bone mineral density and biochemical markers of bone turnover in patients with predialysis chronic renal failure. Kidney Int 56: 1084–1093, 1999 - PubMed
    1. Moe S, Drüeke T, Cunningham J, Goodman W, Martin K, Olgaard K, et al. ; Kidney Disease: Improving Global Outcomes (KDIGO) : Definition, evaluation, and classification of renal osteodystrophy: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 69: 1945–1953, 2006 - PubMed
    1. Coen G, Pierantozzi A, Spizzichino D, Sardella D, Mantella D, Manni M, et al. : Risk factors of one year increment of coronary calcifications and survival in hemodialysis patients. BMC Nephrol 11: 10, 2010 - PMC - PubMed

Publication types