Targeting Vascular Calcification in
Chronic Kidney Disease

Adam J. Nelson, BMEDSC, MD, PHD, Paolo Raggi, MD,b Myles Wolf, MD, MMSC,
Alexander M. Gold, MD, Glenn M. Chertow, MD, MPH, Matthew T. Roe, MD, MHS

  • Vascular calcification is a highly regulated, cell-mediated process that is strongly associated with CKD and confers increased risk for incident CV events.
  • Multiple pathways link vascular calcification with CKD; however, they remain incompletely understood, and the development of targeted therapies has been underwhelming.
  • Illumination of the causal steps and natural history that link vascular calcification to CV events will affirm its role as a CV risk factor and accelerate drug discovery and therapeutic translation


Cardiovascular (CV) disease remains an important cause of morbidity and mortality for patients with chronic kidney disease (CKD). Although clustering of traditional risk factors with CKD is well recognized, kidney-specific mechanisms are believed to drive the disproportionate burden of CV disease. One perturbation that is frequently observed at high rates in patients with CKD is vascular calcification, which may be a central mediator for an array of CV sequelae. This review summarizes the pathophysiological bases of intimal and medial vascular calcification in CKD, current strategies for diagnosis and management, and posits vascular calcification as a risk marker and therapeutic target.
(J Am Coll Cardiol Basic Trans Science 2020;5:398–412) © 2020

The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

This is an open access article under the CC BY-NC-ND license

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