Cardiovascular calcification in end stage renal disease

Extensive atherosclerosis and heavy vascular and valvular calcifications are common complications of end stage chronic kidney disease (CKD-V) and are related to a high incidence of cardiovascular events. In CKD-V vascular calcifications occur both in the subintimal space and in the runica media. Intimal calcification is associated with atherosclerosis and is therefore a universal finding. On the contrary, medial calcification is characteristically associated with advanced CKD and diabetes mellitus. Numerous metabolic and endocrine abnormalities, primarily involving calcium and phosphorus metabolism, are found in CKD. Furthermore, CKD-V is believed to be a state of heightened inflammation and oxidative stress. All of these dysfunctions occur early in the course of the renal failure and likely contribute to the development and progression of vascular calcification and atherosclerosis. This review is centred on the pathobiology of vascular calcification in CKD-V, its detection with modern imaging modalities and the therapeutic approaches currently available to slow its progression.