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慢性肾脏病患者血管钙化的病理生理学和治疗管理。

The pathophysiology and management of vascular calcification in chronic kidney disease patients.

机构信息

Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey.

Department of Health Sciences, Renal Division, University of Milan, ASST Santi Paolo e Carlo, 20142 Milan, Italy.

出版信息

Expert Rev Cardiovasc Ther. 2023 Feb;21(2):75-85. doi: 10.1080/14779072.2023.2174525. Epub 2023 Feb 2.

Abstract

INTRODUCTION

Vascular calcification (VC) which is the pathological mineral deposition in the vascular system, predominantly at the intimal and medial layer of the vessel wall, is an important comorbidity in patients with chronic kidney disease (CKD) leading to significant morbidity and mortality while necessitating appropriate treatment. Our review aims to provide an in-depth analysis of the current understanding of VC.

AREAS COVERED

In this review, we first discuss the pathophysiology of VC in CKD patients, then we explain the methods to predict and assess VC. Afterwards, we provide the currently available as well as the potential therapeutic approaches of VC. We finally discuss our understanding regarding the current situation surrounding VC in our expert opinion section.

EXPERT OPINION

Predicting, assessing and treating VC is crucial and the future advances in the field of research surrounding VC will potentially occur in one or more of these three areas of clinical management. There is a current lack of evidence and consensus regarding specific therapeutic options for alleviating VC and this situation may not necessitate VC to be determined, detected, and documented before the available options are implemented. Regardless, the prediction and assessment of VC is still important and requires further improvement together with the developments in therapeutic alternatives. The future has the potential to bring better research which would guide and improve the management of this patient group. A more specialized approach consisting of targeted therapies and more tailored management plans for patients with CKD and VC is on the horizon.

摘要

简介

血管钙化(VC)是指血管系统中病理性的矿物质沉积,主要发生在血管壁的内膜和中膜层,是慢性肾脏病(CKD)患者的重要合并症,导致发病率和死亡率显著增加,同时需要进行适当的治疗。我们的综述旨在对 VC 的现有认识进行深入分析。

涵盖领域

在本次综述中,我们首先讨论了 CKD 患者 VC 的病理生理学,然后解释了预测和评估 VC 的方法。接下来,我们提供了目前可用的以及潜在的 VC 治疗方法。最后,我们在专家意见部分讨论了我们对 VC 现状的理解。

专家意见

预测、评估和治疗 VC 至关重要,未来围绕 VC 的研究进展可能会出现在临床管理的这三个领域之一或多个领域。目前,针对缓解 VC 的具体治疗方案缺乏证据和共识,这种情况可能并不需要在实施现有方案之前确定、检测和记录 VC。然而,VC 的预测和评估仍然很重要,需要与治疗选择的发展一起进一步改进。未来有可能会带来更好的研究,指导和改善这组患者的管理。针对 CKD 和 VC 患者的靶向治疗和更定制化的管理方案的更专业化方法即将出现。

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