Review
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World J Nephrol. Feb 6, 2012; 1(1): 25-34
Published online Feb 6, 2012. doi: 10.5527/wjn.v1.i1.25
Arterial stiffness, vascular calcification and bone metabolism in chronic kidney disease
János Nemcsik, István Kiss, András Tislér
János Nemcsik, Department of Family Medicine, Semmelweis University, 1125 Budapest, Hungary
István Kiss, Division of Angiology and Nephrology, Department of Medicine, St. Imre Teaching Hospital, 1115 Budapest, Hungary
András Tislér, 1st Department of Medicine, Semmelweis University, 1125 Budapest, Hungary
Author contributions: Nemcsik J solely contributed to this paper; Kiss I and Tislér A revised it critically for important intellectual content.
Correspondence to: János Nemcsik, MD, PhD, Department of Family Medicine, Semmelweis University, Kútvölgyi str. 4, 1125 Budapest, Hungary. nemcsikjanos@yahoo.com
Telephone: +36-14-694667 Fax: +36-13-358530
Received: September 6, 2011
Revised: October 18, 2011
Accepted: December 27, 2011
Published online: February 6, 2012
Abstract

Patients with chronic kidney disease (CKD) have an extremely poor cardiovascular outcome. Arterial stiffness, a strong independent predictor of survival in CKD, is connected to arterial media calcification. A huge number of different factors contribute to the increased arterial calcification and stiffening in CKD, a process which is in parallel with impaired bone metabolism. This coincidence was demonstrated to be part of the direct inhibition of calcification in the vessels, which is a counterbalancing effect but also leads to low bone turnover. Due to the growing evidence, the definition of “CKD mineral bone disorder” was created recently, underlining the strong connection of the two phenomena. In this review, we aim to demonstrate the mechanisms leading to increased arterial stiffness and the up-to date data of the bone-vascular axis in CKD. We overview a list of the different factors, including inhibitors of bone metabolism like osteoprotegerin, fetuin-A, pyrophosphates, matrix Gla protein, osteopontin, fibroblast growth factor 23 and bone morphogenic protein, which seem to play role in the progression of vascular calcification and we evaluate their connection to impaired arterial stiffness in the mirror of recent scientific results.

Keywords: Arterial stiffness, Vascular calcification, Bone metabolism, Chronic kidney disease