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Updated: Mar 9, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Mineral metabolism and cardiovascular disease in CKD
1Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan.
Insights
Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) significantly impacts cardiovascular disease in CKD patients. Beyond vascular calcification, factors like FGF23 and treatment-induced arrhythmias define a CKD-MBD cardiac complex syndrome.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) is a critical factor in cardiovascular disease (CVD) progression among CKD patients.
- Traditionally, CKD-MBD's cardiovascular impact has focused on bone and laboratory abnormalities, and vascular calcifications.
- Emerging evidence highlights CKD-MBD factors beyond vascular calcification contributing to CVD.
Purpose of the Study:
- To explore CKD-MBD-specific factors contributing to cardiovascular disease in CKD patients.
- To characterize the distinct cardiac manifestations associated with CKD-MBD.
- To define a novel 'CKD-MBD-specific cardiac complex syndrome'.
Main Methods:
- Review of recent compelling evidence and clinical observations.
- Analysis of the role of fibroblast growth factor-23 (FGF23) in cardiac remodeling.
- Examination of treatment-related factors (e.g., low calcium dialysate, calcimimetics) and their impact on cardiac events.
Main Results:
- Fibroblast growth factor-23 (FGF23) is independently associated with cardiac remodeling in CKD-MBD.
- CKD-MBD cardiac disease typically progresses slowly via vascular calcification and remodeling.
- Sudden fatal arrhythmias, heart failure, and sudden cardiac death can occur, particularly with QT prolongation during CKD-MBD treatment.
Conclusions:
- CKD-MBD contributes to cardiovascular disease through mechanisms beyond vascular calcification.
- A distinct 'CKD-MBD-specific cardiac complex syndrome' is proposed, characterized by slow progression and sudden fatal arrhythmias.
- Understanding these specific factors is crucial for managing cardiovascular risk in CKD patients.
Abstract:
The mineral bone disorder of CKD, called Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD), has a major role in the etiology and progression of cardiovascular disease in CKD patients. Since the main emphasis in CKD-MBD is on three categories (bone abnormalities, laboratory abnormalities, and vascular calcifications), we have routinely accepted ectopic cardiovascular calcifications as a central risk factor in the pathophysiology of CKD-MBD for cardiac events. However, recent compelling evidence suggests that some CKD-MBD-specific factors other than vascular calcification might contribute to the onset of cardiovascular disease. Most notable is fibroblast growth factor-23 (FGF23), which is thought to be independently associated with cardiac remodeling. Slow progression of cardiac disorders, such as vascular calcification and cardiac remodeling, characterizes cardiac disease due to CKD-MBD. In contrast, fatal arrhythmia may be induced when QT prolongation occurs with CKD-MBD treatment, such as with lower Ca dialysate or the use of calcimimetics. Sudden onset of fatal cardiac events, such as heart failure and sudden cardiac death, due to fatal arrhythmia would be another distinctive phenomenon of CKD-MBD. This may be defined as CKD-MBD-specific cardiac complex syndrome.
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