Risk factors associated with medial arterial calcification (MAC) versus atherosclerosis in CKD (above). Simplified histopathology pictures of the MAC and atherosclerotic calcification (below). Disordered mineral metabolism in CKD with its associated characteristics of hyperphosphatemia, hypercalcemia, and renal osteodystrophy, as well as vitamin D perturbation and klotho deficiency, increases the risk for MAC. Oxidative stress and chronic inflammation in uremia also accelerate atherosclerosis. A number of risk factors can drive both pathologies. Both atherosclerotic calcification and medial calcification stiffen arterial conduit vessels, impairing heart function. The eccentric remodeling of atherosclerotic calcification also reduces lumen diameter and predisposes to acute thrombosis.
