Vascular Calcification and Renal Bone Disorders

Table 1

The possible treatments of vascular calcification in CKD.


General principle
(1) Treat hypertension, hyperlipidemia, and hyperglycemia as usual
(2) Body weight control
(3) Control serum and urine phosphate
(4) Avoid hypercalcemia
(5) Avoid magnesium, Iron, and L-lysine deficiency
(6) Nutritional vitamin-D (NVD) supplement (avoid high dose of VDRAs)
(7) Possible fractionated heparin for dialysis
(8) AST-120

Manipulating the complex biology of vascular calcification
(1) Pyrophosphate
(2) Na thiosulfate
(3) Vit-K (especially in warfarin user)
(4) Avoid zinc deficiency
(5) Avoid excess of vit-E, vit-A, vit-C, and fluoride
(6) Antioxidants (?)

Patients with high turnover bone disorder (e.g., hyperparathyroid bone disorder; iPTH > 300 pg/mL + high level BAP)
(1) VDRA (paricalcitol/calcitriol) + NVD (cholecalciferol/ergocalciferol) or calcimimetics + NVD
(2) Non-metal-containing phosphate binders—sevelamer (for phosphorus)
(3) Bisphosphonate + VDRA/NVD (for high PTH + hypercalcemia + low bone mass)
(4) Denosumab + VDRA/NVD (for high PTH + hypercalcemia + low bone mass)

Patients with low turnover bone disorder (e.g., adynamic bone disorder; bone alkaline phosphatase < 20 ng/mL, and iPTH < 100 pg/mL)
(1) NVD + low dose VDRA
(2) Teriparatide
(3) Non-metal-containing phosphate binders—sevelamer (for oxidative stress and inflammation)