Biology of vascular calcification in chronic kidney disease
- Behdad Afzali, MRCP, PhD, PGDip, FHEA, MAcadMEd
Behdad Afzali, MRCP, PhD, PGDip, FHEA, MAcadMEd
- Wellcome Trust Intermediate Research Fellow
- King's College Honorary Consultant Nephrologist
- Guy's and St Thomas's Hospitals, NHS Trust, UK
- Guest Researcher, National Institutes of Health, USA
- David JA Goldsmith, MA, FRCP
David JA Goldsmith, MA, FRCP
- Department of Nephrology and Transplantation
- Guy's Hospital, London
The most common cause of death in chronic kidney disease (CKD) patients is cardiovascular disease (CVD), often related to sudden cardiac death (SCD). (See "Myocardial dysfunction in end-stage renal disease" and "Evaluation of sudden cardiac arrest and sudden cardiac death in dialysis patients".)
It is hypothesized that SCD is related, at least in part, to excess vascular calcification (VC), particularly in the form of extensive coronary artery calcification (CAC) affecting epicardial and smaller arteries [1-4]. (See "Patient survival and maintenance dialysis" and "Diagnostic and prognostic implications of coronary artery calcification detected by computed tomography".)
Vascular or valvular arterial calcifications may also contribute to microembolic disease, an increased risk of cardiac valvular dysfunction and infection (endocarditis), and surgical difficulties placing an arteriovenous fistula or transplanting a kidney.
This topic reviews the definition and pathogenesis of VC, particularly CAC, in dialysis patients. Risk factors, epidemiology, and clinical implications of VC in renal disease are discussed separately. (See "Vascular calcification in chronic kidney disease".)
All large and medium-sized muscular arteries and arterioles can calcify. By comparison, veins hardly ever undergo calcification, unless injured or arterialized . As examples, calcification associated with arteriolization may occur after coronary artery bypass grafting or arteriovenous fistula formation or in the pulmonary arterial tree of patients with pulmonary hypertension .
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