Vascular Calcification in Chronic Kidney Disease: Distinct Features of Pathogenesis and Clinical Implication

Author's summary This paper comprehensively reviews the latest evidence regarding interventional approach to highly calcified coronary lesions in the catheterization laboratory. It covers the epidemiology, diagnostic tools and interventional strategies for calcified coronary artery disease. The introduction of various new diagnostic and interventional tools have completely changed the landscape of approach to coronary calcium in the past 2 decades. However, the optimal approach to this therapeutically challenging entity remains controversial. This review paper proposes a management algorithm based on latest evidence on diagnosis and intervention to calcified coronary artery disease.

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“… 3) Male gender, white race, metabolic syndrome, uremia and diabetes mellitus all increase risk of coronary calcification. 4) 5) 6) 7) …”

Section: Epidemiology and Outcomesmentioning

confidence: 99%

Contemporary Interventional Approach to Calcified Coronary Artery Disease

Sung

Lam

2023

Korean Circ J

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“…The α-klotho protein functions as a co-receptor or scaffold protein for the fibroblast growth factor (FGF) receptor (FGFR). Binding of FGF23 produced in bone to the renal FGFR regulates phosphate reabsorption and calcitriol production in the kidney; therefore impaired FGF23 activity due to reduced α-klotho expression leads to dysregulation of phosphate and vitamin D homeostasis thereby contributing to vascular calcification [ 26 ]. Phosphatemia is also associated with increased ROS and free radicals, which can inhibit endothelial NO synthase (NOS) activity to reduce NO productionand increase peroxynitrite (ONOO – ) generation [ 27 ].…”

Section: Vascular Injurymentioning

confidence: 99%

Pathomechanism of oxidative stress in cardiovascularrenal remodeling and therapeutic strategies

Ravarotto

Bertoldi

Stefanelli

et al. 2022

Kidney Res Clin Pract

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The high prevalence of cardiovascular disease in patients with chronic kidney disease indicates significant interactions between pathogenic pathways operating in the kidney and heart. These interactions involve all cell types (endothelial cells, smooth muscle cells, macrophages, and others), components of the vasculature, glomeruli, and heart that are susceptible to oxidative damage and structural alterations. A vicious cycle occurs whereby harmful factors such as reactive oxygen species and inflammation damage of vascular structures that themselves become sources of additional dangerous/toxic components released into the local environment. The evidence of this vicious cycle in chronic kidney disease should therefore lead to add other factors to both traditional and nontraditional risk factors. This review will examine the processes occurring during progressive kidney dysfunction with regard to vascular injury, renal remodeling, cardiac hypertrophy, and the transversal role of oxidative stress in the development of these complications.

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“…Prior studies have shown that both traditional and non-traditional risk factors are multifactorial in the pathogenesis of CVD in patients with ESRD. Moreover, it is difficult to predict the occurrence of cardiovascular (CV) events in these patients [ 2 ]. ESRD patients with CVD often show no or atypical symptoms, resulting in delayed diagnosis and failure to receive appropriate management of CVD.…”

Section: Introductionmentioning

confidence: 99%

“…Patients with ESRD have a high prevalence of vascular calcification, which shows distinct pathophysiological features compared to those in the general population [ 2 , 10 ]. Patients with ESRD undergoing HD are at risk of atherosclerotic injury because they are constantly exposed to endothelial injury, oxidative stress, and inflammation.…”

Section: Introductionmentioning

confidence: 99%

Circulatory endostatin level and risk of cardiovascular events in patients with end-stage renal disease on hemodialysis

Kim,

Jeong

et al. 2024

Kidney Res Clin Pract

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Background: Endostatin is released during extracellular matrix remodeling and is involved in the development of vascular pathology and cardiovascular (CV) disease. However, the role of circulating endostatin as a biomarker of vascular calcification and CV events in patients undergoing hemodialysis (HD) remains unclear. Methods: A total of 372 patients undergoing HD were prospectively recruited. Plasma endostatin levels were measured at baseline, and their associations with circulating mineral bone disease (MBD) biomarkers and abdominal aortic vascular calcification scores were analyzed. The primary endpoint was defined as a composite of CV and cardiac events. Results: Plasma levels of patients in endostatin tertile 3 were significantly associated with low-density lipoprotein cholesterol levels and predialysis systolic blood pressure in multivariate analysis. However, endostatin levels did not correlate with circulating MBD biomarkers or vascular calcification scores. Patients in endostatin tertile 3 had a significantly higher cumulative event rate for the composite of CV events (p = 0.006). Endostatin tertile 3 was also associated with an increased cumulative rate of cardiac events (p = 0.04). In multivariate Cox regression analyses, endostatin tertile 3 was associated with a 4.37-fold risk for composite CV events and a 3.88-fold risk for cardiac events after adjusting for multiple variables. Conclusion: Higher circulating endostatin levels were independently associated with atherosclerotic risk factors but did not correlate with MBD markers or vascular calcification. Higher circulating endostatin levels were associated with a greater risk of composite CV events in patients undergoing HD, and endostatin is a biomarker that helps to determine the high risk of CV events.

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Vascular Calcification in Chronic Kidney Disease: Distinct Features of Pathogenesis and Clinical Implication

Cited by 29 publications

References 176 publications

Contemporary Interventional Approach to Calcified Coronary Artery Disease

Contemporary Interventional Approach to Calcified Coronary Artery Disease

Pathomechanism of oxidative stress in cardiovascularrenal remodeling and therapeutic strategies

Circulatory endostatin level and risk of cardiovascular events in patients with end-stage renal disease on hemodialysis

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