Should nephrologists consider vascular calcification screening?

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Vascular calcification (VC) is a major contributor to cardiovascular (CV) disease burden among patients with chronic kidney disease (CKD). The age‐ and gender‐standardised risk of VC is twofold to fivefold higher in patients with CKD compared with the general population.1 VC is characterised by intimal and medial wall thickening and loss of elasticity, primarily through accelerated atherosclerosis and arteriosclerosis.3 VC is an active and complex process closely regulated by a growing list of inducers and inhibitors, including phosphate, calcium, inflammatory cytokines, fetuin‐A, matrix Gla protein, osteoprotegerin and pyrophosphate.4 Accelerated atherosclerosis and calcification of both medial and intimal layers of coronary and systemic arteries result in reduced coronary perfusion and increased arterial stiffness, and subsequently contributes to adverse CV events and mortality among patients with CKD.5 In fact, the odds ratio for any CV event in the presence of VC was reported to be sixfold higher among patients with CKD.8 Because of this direct link to adverse outcomes, VC assessment has gained tremendous interest as a screening tool to refine CV risk stratification and as a surrogate endpoint for various CV interventions.
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