Brancaccio Diego, Bellasi Antonio, Cozzolino Mario, Galassi Andrea, Gallieni Maurizio
Department of Nephrology, San Paolo Hospital, University of Milan, Italy. diego.brancaccio@ tiscalinet.it
Curr Vasc Pharmacol. 2009 Jul;7(3):374-80. doi: 10.2174/157016109788340730.
Chronic Kidney Disease Mineral and Bone Disorder (CKD-MBD) is a systemic disorder of mineral and bone metabolism that occurs in Chronic Kidney Disease (CKD). In addition to abnormalities in serum calcium (Ca) and phosphate (P) profile, CKD-MBD is characterized by abnormalities of bone turnover, mineralization, volume and growth as well as vascular calcification (VC). Indeed, the co-localization of bone markers such as Osteopontin, Alkaline Phosphatase and Osteocalcin along with osteoblast-like cells in the contest of the arterial wall of uremic patients, indicate that VC is an active biological process with peculiar analogies with bone mineralization. Thus, VC represents a plausible link between Ca and P derangements and the increased mortality associated with CKD-MBD. The process of VC starts in early stages of CKD and patients with CKD-3, -4 and -5 not undergoing haemodialysis may present a significant burden of calcification in the coronaries. Considering that presence and extent of VC in CKD portend poor prognosis, many efforts have been made to shed light on this complicated phenomenon to prevent VC deposition and progression. Indeed, careful control of calcium load, serum P and parathyroid hormone along with the use of calcium-free P binders and vitamin D analogs represent our current armamentarium to improve quality of life and reduce mortality in CKD. We herein summarize the current understanding and evidence supporting strategies available for VC treatment.
慢性肾脏病矿物质和骨异常（CKD-MBD）是一种发生于慢性肾脏病（CKD）的矿物质和骨代谢的全身性紊乱。除血清钙（Ca）和磷（P）水平异常外，CKD-MBD的特征还包括骨转换、矿化、体积和生长异常以及血管钙化（VC）。实际上，在尿毒症患者动脉壁中，骨桥蛋白、碱性磷酸酶和骨钙素等骨标志物与成骨样细胞共定位，这表明VC是一个与骨矿化有特殊相似之处的活跃生物学过程。因此，VC是Ca和P紊乱与CKD-MBD相关死亡率增加之间的一个合理联系。VC过程始于CKD的早期阶段，未接受血液透析的CKD-3、-4和-5期患者冠状动脉中可能存在明显的钙化负担。鉴于CKD中VC的存在和程度预示着不良预后，人们已做出许多努力来阐明这一复杂现象，以防止VC沉积和进展。事实上，仔细控制钙负荷、血清P和甲状旁腺激素，同时使用无钙P结合剂和维生素D类似物，是我们目前改善CKD患者生活质量和降低死亡率的手段。我们在此总结了目前对VC治疗可用策略的认识和支持证据。
