Update on Chronic Kidney Disease Mineral and Bone Disorder in Cardiovascular Disease

Abstract

The Chronic Kidney Disease (CKD) Mineral and Bone Disorder (MBD) encompasses changes in mineral ion and vitamin D metabolism that are widespread in the setting of CKD and end-stage renal disease (ESRD). MBD components associate with cardiovascular disease in many epidemiologic studies. Through impacts on hypertension, activation of the renin-angiotensin-aldosterone system, vascular calcification, endothelial function, and cardiac remodeling and conduction, MBD may be a direct and targetable cause of cardiovascular disease. However, assessment and treatment of MBD is rife with challenges due to biological tensions between its many components, such as: calcium and phosphorus with their regulatory hormones fibroblast growth factor 23 and parathyroid hormone; fibroblast growth factor 23 with its co-receptor klotho; and vitamin D with control of calcium and phosphorus. These complex interactions between MBD components hinder the simple translation to clinical trials, which are ultimately needed to prove the benefits of treating MBD. Deeper investigation using precision medicine tools and principles, including genomics and individualized risk assessment and therapy may help move the field closer towards clinical applications. This review will provide a high level overview of conventional and ‘precision’ epidemiology in MBD, potential mechanisms of cardiovascular disease pathogenesis, and guiding therapeutic principles for established and emerging treatments.

Gla-Rich Protein (GRP) as an Early and Novel Marker of Vascular Calcification and Kidney Dysfunction in Diabetic Patients with CKD: A Pilot Cross-Sectional Study

“…In addition to traditional risk factors, most patients with CKD display abnormal mineral metabolism (MM) with underlying hormonal dysregulation, defined as chronic kidney disease-mineral and bone disorder (CKD-MBD) [4]. CKD-MBD involves changes in mineral ion homeostasis, bone quality and turnover, cardiovascular and soft tissue calcifications, which highly contribute for cardiovascular complications [4,5]. Vascular calcification (VC) is associated with significant morbidity and mortality and a strong predictor of cardiovascular risk in CKD patients [6,7].…”

The interplay between mineral metabolism, vascular calcification and inflammation in Chronic Kidney Disease (CKD): challenging old concepts with new facts

“…This is partially due to vascular calcification (VC) and accelerated atherosclerosis, as a result of the mineral and bone disorder (MBD) that often accompanies low kidney function and complicates CKD. CKD-MBD involves changes in mineral ion homeostasis, bone quality and turnover, and extraskeletal calcification [8,9].…”

A Combination of Hemodialysis with Hemoperfusion Helped to Reduce the Cardiovascular-Related Mortality Rate after a 3-Year Follow-Up: A Pilot Study in Vietnam

“…Second, PTH appears also to have detrimental effects on the myocardium via induction of left ventricular hypertrophy and cardiac calcification. Higher PTH is associated with both established cardiovascular risk factors and more recently described risk factors such as inflammation markers [28-30]. Finally, because PTH is one of the key regulatory hormones in the mineral homeostasis, it is possible that the plasma levels of PTH reflect other abnormalities along the same pathway such as vitamin D deficiency, hypercalcemia, hyperphosphatemia, or renal failure that predispose to a higher risk for cardiovascular mortality [28-30].…”