Kakani Elijah, Elyamny Mohamed, Ayach Taha, El-Husseini Amr
Division of Hospital Medicine, University of Kentucky, Lexington, KY, USA.
Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY, USA.
Semin Dial. 2019 Nov;32(6):553-561. doi: 10.1111/sdi.12840. Epub 2019 Aug 29.
Patients with chronic kidney disease (CKD) have a predisposition to develop vascular calcification due to dysregulated homeostatic mechanisms, which lead to an imbalance in the circulatory promoters and inhibitors of vascular calcification, leading to a net calcification stress. These factors promote ectopic calcification and induce vascular smooth muscle cells to undergo osteogenic differentiation and actively calcify the vascular media. The article summarizes clinically relevant pathogenic mechanisms of vascular calcification in patients with CKD and in dialysis patients and summarizes novel therapeutic interventions. In addition to the management of traditional cardiovascular risk factors, patients with CKD-mineral and bone disorder need close attention in the management of the mineral metabolism to prevent adverse effects on the bone and vascular compartments. This article reviews current evidence and therapeutic guidelines in the management of mineral metabolism in CKD and dialysis.
慢性肾脏病（CKD）患者由于体内稳态机制失调，易发生血管钙化，这会导致血管钙化的循环促进因子和抑制因子失衡，进而产生净钙化应激。这些因素促进异位钙化，并诱导血管平滑肌细胞发生成骨分化，使血管中层主动钙化。本文总结了CKD患者及透析患者血管钙化的临床相关致病机制，并总结了新的治疗干预措施。除了管理传统心血管危险因素外，CKD-矿物质和骨异常患者在矿物质代谢管理方面需要密切关注，以防止对骨骼和血管系统产生不良影响。本文综述了CKD和透析患者矿物质代谢管理的当前证据和治疗指南。
