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Published on: May 31, 2016
The Key Role of Phosphate on Vascular Calcification
Mario Cozzolino1, Paola Ciceri2, Andrea Galassi3
1Renal Division, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy. mario.cozzolino@unimi.it.
Insights
Vascular calcification is a hallmark of chronic kidney disease (CKD), increasing cardiovascular disease risk. Managing calcium and phosphate balance is crucial, as specific therapies to reverse vascular calcification are lacking.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Vascular Biology
Background:
- Vascular calcification (VC) is prevalent in chronic kidney disease (CKD) patients, irrespective of dialysis status.
- VC is considered a hallmark of CKD and is linked to cardiovascular disease (CVD) and mortality.
- VC manifests in various forms, each indicating systemic vascular disease and higher CVD prevalence in CKD.
Purpose of the Study:
- To review the significance of vascular calcification in CKD.
- To identify major risk factors contributing to VC in CKD patients.
- To discuss current management strategies and the lack of specific therapies for VC.
Main Methods:
- Literature review of clinical studies on vascular calcification in CKD.
- Analysis of risk factors associated with VC progression.
- Evaluation of the impact of phosphate binders on VC.
Main Results:
- Key risk factors for VC in CKD include advanced age, long dialysis vintage, hyperphosphatemia, hypercalcemia, and positive calcium/phosphate balance.
- Excessive oral calcium intake and calcium-based phosphate binders exacerbate VC.
- Non-calcium-based phosphate binders are associated with reduced VC progression.
Conclusions:
- VC is a significant complication in CKD, associated with increased CVD risk.
- Management should focus on balancing calcium and phosphate levels.
- Effective therapies to prevent or reverse VC in CKD are currently unavailable.
Abstract:
Vascular calcification (VC) is common in dialysis and non-dialysis chronic kidney disease (CKD) patients, even in the early stage of the disease. For this reason, it can be considered a CKD hallmark. VC contributes to cardiovascular disease (CVD) and increased mortality among CKD patients, although it has not been proven. There are more than one type of VC and every form represents a marker of systemic vascular disease and is associated with a higher prevalence of CVD in CKD patients, as shown by several clinical studies. Major risk factors for VC in CKD include: Increasing age, dialysis vintage, hyperphosphatemia (particularly in the setting of intermittent or persistent hypercalcemia), and a positive net calcium and phosphate balance. Excessive oral calcium intake, including calcium-containing phosphate binders, increases the risk for VC. Moreover, it has been demonstrated that there is less VC progression with non-calcium-containing phosphate binders. Unfortunately, until now, a specific therapy to prevent progression or to facilitate regression of VC has been found, beyond careful attention to calcium and phosphate balance.
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