Vascular calcification: When should we interfere in chronic kidney disease patients and how?

Area of Science:

• Nephrology
• Cardiology
• Vascular Biology

Background:

• Chronic kidney disease (CKD) is associated with high mortality rates, with cardiovascular events causing up to 60% of deaths.
• Vascular calcification is prevalent in CKD patients, often linked to impaired renal phosphate handling.
• Fibroblast growth factor 23 (FGF23) and klotho deficiency play key roles in vascular calcification pathogenesis.

Purpose of the Study:

• To review the medical history, prevalence, and pathogenesis of vascular calcification in CKD.
• To discuss diagnostic tools, optimal timing for intervention, and management strategies for vascular calcification in CKD.
• To explore the emerging role of the gut microbiome in CKD-related systemic inflammation and vascular calcification.

Main Methods:

• Comprehensive literature review of studies on CKD, cardiovascular disease, and vascular calcification.
• Analysis of mechanisms involving FGF23, klotho, and gut-derived factors in CKD pathogenesis.
• Synthesis of information on diagnostic modalities and therapeutic interventions.

Main Results:

• Disturbed phosphate handling, FGF23/klotho imbalances, and deficient klotho expression contribute significantly to vascular calcification in CKD.
• The gut microbiome's role in systemic inflammation and vascular calcification is an emerging area of research.
• Early diagnosis and intervention are crucial for managing vascular calcification and improving outcomes.

Conclusions:

• Vascular calcification is a major driver of cardiovascular mortality in CKD patients.
• Targeting phosphate handling, FGF23/klotho pathways, and potentially the gut microbiome offers therapeutic avenues.
• A multidisciplinary approach is needed to manage vascular calcification and enhance survival in CKD.