Are there ways to attenuate arterial calcification and improve cardiovascular outcomes in chronic kidney disease?

Abstract

The risk of cardiovascular mortality among patients with end-stage renal disease is several times higher than general population. Arterial calcification, a marker of atherosclerosis and a predictor of cardiovascular mortality, is common in chronic kidney disease (CKD). The presence of traditional cardiovascular risk factors such as diabetes, hypertension, hyperlipidemia, and advanced age cannot fully explain the high prevalence of atherosclerosis and arterial calcification. Other factors specific to CKD such as hyperphosphatemia, excess of calcium, high dose active vitamin D and prolonged dialysis vintage play important roles in the development of arterial calcification. Due to the significant health risk, it is prudent to attempt to lower arterial calcification burden in CKD. Treatment of hyperlipidemia with statin has failed to lower atherosclerotic and arterial calcification burden. Data on diabetes and blood pressure controls as well as smoking cessation on cardiovascular outcomes in CKD population are limited. Currently available treatment options include non-calcium containing phosphate binders, low dose active vitamin D, calcimimetic agent and perhaps bisphosphonates, vitamin K and sodium thiosulfate. Preliminary data on bisphosphonates, vitamin K and sodium thiosulfate are encouraging but larger studies on efficacy and outcomes are needed.

Keywords: Vascular calcification; Coronary calcification; Hemodialysis; Dialysis; Chronic kidney disease

Core tip: Arterial calcification is common in chronic kidney disease (CKD). Factors specific to CKD such as hyperphosphatemia, excess of calcium and high dose vitamin D therapy play important roles in the development of arterial calcification. Statin is ineffective in lowering the calcification burden. Data on diabetes and blood pressure controls and smoking cessation on cardiovascular outcomes in CKD population are limited. Available treatment strategies include non-calcium containing phosphate binders, low dose active vitamin D and calcimimetic agent. Preliminary data on bisphosphonates, vitamin K and sodium thiosulfate are encouraging but larger studies on efficacy and outcomes are needed.