Pathogenesis and management of vascular calcification in CKD and dialysis patients

Semin Dial. 2019 Nov;32(6):553-561. doi: 10.1111/sdi.12840. Epub 2019 Aug 29.


Patients with chronic kidney disease (CKD) have a predisposition to develop vascular calcification due to dysregulated homeostatic mechanisms, which lead to an imbalance in the circulatory promoters and inhibitors of vascular calcification, leading to a net calcification stress. These factors promote ectopic calcification and induce vascular smooth muscle cells to undergo osteogenic differentiation and actively calcify the vascular media. The article summarizes clinically relevant pathogenic mechanisms of vascular calcification in patients with CKD and in dialysis patients and summarizes novel therapeutic interventions. In addition to the management of traditional cardiovascular risk factors, patients with CKD-mineral and bone disorder need close attention in the management of the mineral metabolism to prevent adverse effects on the bone and vascular compartments. This article reviews current evidence and therapeutic guidelines in the management of mineral metabolism in CKD and dialysis.

Publication types

  • Review

MeSH terms

  • Calciphylaxis / drug therapy
  • Calciphylaxis / pathology*
  • Calciphylaxis / physiopathology
  • Calcitriol / therapeutic use
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / prevention & control
  • Chronic Kidney Disease-Mineral and Bone Disorder / drug therapy
  • Chronic Kidney Disease-Mineral and Bone Disorder / etiology
  • Chronic Kidney Disease-Mineral and Bone Disorder / physiopathology*
  • Cinacalcet / administration & dosage
  • Comorbidity
  • Female
  • Humans
  • Incidence
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / epidemiology*
  • Kidney Failure, Chronic / therapy
  • Male
  • Prognosis
  • Renal Dialysis / adverse effects*
  • Renal Dialysis / methods
  • Risk Assessment
  • Severity of Illness Index
  • Treatment Outcome
  • Vascular Calcification / drug therapy
  • Vascular Calcification / epidemiology*
  • Vascular Calcification / pathology*
  • Vitamin D / administration & dosage


  • Vitamin D
  • Calcitriol
  • Cinacalcet