Are there ways to attenuate arterial calcification and improve cardiovascular outcomes in chronic kidney disease?

The risk of cardiovascular mortality among patientswith end-stage renal disease is several times higherthan general population. Arterial calcification, a markerof atherosclerosis and a predictor of cardiovascularmortality, is common in chronic kidney disease(CKD).The presence of traditional cardiovascular risk factorssuch as diabetes, hypertension, hyperlipidemia, and ad-vanced age cannot fully explain the high prevalence ofatherosclerosis and arterial calcification. Other factorsspecific to CKD such as hyperphosphatemia, excess ofcalcium, high dose active vitamin D and prolonged di-alysis vintage play important roles in the developmentof arterial calcification. Due to the significant healthrisk, it is prudent to attempt to lower arterial calcifica-tion burden in CKD. Treatment of hyperlipidemia withstatin has failed to lower atherosclerotic and arteriacalcification burden. Data on diabetes and blood pres-sure controls as well as smoking cessation on cardio-vascular outcomes in CKD population are limited. Cur-rently available treatment options include non-calciumcontaining phosphate binders, low dose active vitamin D, calcimimetic agent and perhaps bisphosphonates, vitamin K and sodium thiosulfate. Preliminary data on bisphosphonates, vitamin K and sodium thiosulfate are encouraging but larger studies on efficacy and out-comes are needed.