Ten years of progress in our understanding of uremic vascular calcification and disease: A decade summarized in 20 steps

Abstract

Accelerated vascular calcification is a hallmark of patients with chronic kidney disease (CKD) and contributes substantially to the enormous disease burden and high mortality in these patients. Within the last 10 years, many authors have significantly contributed to the progress that has been made in our understanding of how important the problem of vascular calcification is for CKD and end-stage renal disease patients. In parallel, our knowledge has substantially increased about the pathophysiology of vascular disease. In consequence, dialysis patient care has undergone significant changes in the last decade. Our review focuses on publications on vascular health in uremia during the period 2000-2010, and we have chosen 20 landmark publications out of this decade that help us to summarize the increasing knowledge on this issue. Two guidelines (Kidney Disease Outcomes Quality Initiative 2003 and Kidney Disease: Improving Global Outcomes 2009) have been published with a strong focus upon bone, mineral, and cardiovascular disorders. These 20 publications highlight in a chronological step-by-step approach the developments and progress that have been made in the field of 'vascular calcification in uremia'. This subjective review of selected contributions attempts to bridge the gap from basic science data about the role of phosphate, Klotho, and vitamin D to vascular wall biology, and integrates clinical and epidemiological data, which have substantially influenced CKD patient care regarding vascular health.