Vascular Calcifications, Major Risk Factor for Cardiovascular Events in Chronic Kidney Disease: An Update on the Pathophy…


Hypertension, diabetes mellitus, dyslipidaemia are frequently encountered in patients with chronic kidney disease (CKD) (1). They are the major risk factors for the development and progression of the endothelial dysfunction and atherosclerosis and contribute to the progression of renal failure (1). Microalbuminuria increases to two- to four-fold the cardiovascular risk (1). It is also a quantitative association between glomerular filtration rate (GFR) and cardiovascular risk (1). The risk increase to two to four-fold in stage 3 of CKD (GFR 30-59 mL/min/1.73 m²), four- to 10-fold in stage 4 (GFR 15-29 mL/min/1.73 m²) and 10- to 50-fold in stage 5 renal failure (GFR <15 mL/min/1.73 m² OR dialysis) in comparison with persons free of CKD (1). Atherosclerosis with intimal involvement and Moenckeberg’s media sclerosis are the main cardiovascular determinations in CKD. Coronary artery calcifications attain the highest levels in young adults patients with renal failure and dialysis, as has been shown in angiographic studies (2). These patients have many coronary risk factors leading to intimal calcifications and these are coexisting with medial calcification founded only in CKD (2). The degree of coronary artery calcifications seems to be related to the estimated GFR in a multivariate analysis (2).

KDIGO guidelines recommend that patients with CKD stages 3-5D with known vascular/valvular calcification be considered at highest cardiovascular risk (class 2A recommendations) (3).