Chronic Kidney Disease with Mineral Bone Disorder and Vascular Calcification: An Overview

Abstract

Chronic kidney disease (CKD) is a global health issue with a rising prevalence, affecting 697.5 million people worldwide. It imposes a substantial burden, contributing to 35.8 million disability-adjusted life years (DALYs) and 1.2 million deaths in 2017. The mortality rate for CKD has increased by 41.5% between 1990 and 2017, positioning it as a significant cause of global mortality. CKD is associated with diverse health complications, impacting cardiovascular, neurological, nutritional, and endocrine aspects. One prominent complication is CKD-mineral and bone disorder (MBD), a complex condition involving dysregulation of bone turnover, mineralization, and strength, accompanied by soft tissue and vascular calcification. Alterations in mineral metabolism, including calcium, phosphate, parathyroid hormone (PTH), vitamin D, fibroblast growth factor-23 (FGF-23), and Klotho, play pivotal roles in CKD-MBD. These disturbances, observed early in CKD, contribute to the progression of bone disorders and renal osteodystrophy (ROD). Vascular calcification (VC) is a key component of CKD-MBD, accelerated by CKD. The pathophysiology involves complex processes in vascular smooth muscle cells and the formation of calciprotein particles (CPP). VC is closely linked to cardiovascular events and mortality, emphasizing its prognostic significance. Various serum markers and imaging techniques, including lateral plain X-ray, Kauppila Score, Adragao Score, and pulse wave velocity, aid in VC detection. Additionally, pQCT provides valuable information on arterial calcifications, offering an advantage over traditional scoring systems. CKD poses a substantial global health burden, and its complications, including CKD-MBD and VC, significantly contribute to morbidity and mortality. Understanding the intricate relationships between mineral metabolism, bone disorders, and vascular calcification is crucial for effective diagnosis and therapeutic interventions.

Keywords: cardiovascular disease (CVD); chronic kidney disease (CKD); imaging techniques; renal osteodystrophy; serum markers; vascular calcification.

Figure 1

Schematic representation of the intricate network involving mediators of chronic kidney disease–mineral bone disorder (CKD–MBD) and vascular calcification. Abbreviations: CKD–MBD, chronic kidney disease–mineral and bone disorder; MGP, Matrix Gla protein; BMP, bone morphogenetic protein; AGE, advanced glycated end-products; AGE-rs, advanced glycated end-products soluble receptors; OPG, osteoprotegerin; ROS, reactive oxygen species; FGF23, fibroblast growth factor 23; PTH, parathyroid hormone; Ca, calcium; Pi, inorganic phosphate.