Should We Consider the Cardiovascular System While Evaluating CKD-MBD?

Area of Science:

• Nephrology
• Cardiology
• Biochemistry

Background:

• Cardiovascular (CV) disease is highly prevalent in patients with chronic kidney disease (CKD).
• The risk of CV death in early CKD stages significantly outweighs the risk of dialysis progression.
• Chronic kidney disease-mineral and bone disorder (CKD-MBD) is strongly associated with CV events and mortality.

Purpose of the Study:

• To summarize the association between CV comorbidities and CKD-MBD biomarkers.
• To explore the role of both established and novel CKD-MBD biomarkers in CV disease within the CKD population.

Main Methods:

• Literature review and synthesis of existing research.
• Analysis of the correlation between CKD-MBD biomarkers and CV outcomes.
• Focus on older biomarkers (parathyroid hormone, phosphate) and newer biomarkers (FGF23, Klotho, sclerostin).

Main Results:

• CKD-MBD biomarkers show a strong correlation with CV events and mortality in CKD patients.
• The non-atheromatous nature of CKD-MBD may explain the limited impact of standard CV drugs.
• Both older (PTH, phosphate) and newer (FGF23, Klotho, sclerostin) biomarkers are implicated.

Conclusions:

• CKD-MBD plays a significant role in the high CV burden seen in CKD.
• Novel biomarkers like FGF23, Klotho, and sclerostin offer potential insights into CV risk in CKD.
• Understanding these associations is crucial for developing targeted therapies for CV disease in CKD patients.