Vascular calcification in uremia: what is new and where are we going?

Arterial calcification is very common in patients with chronic kidney disease (CKD) and other chronic inflammatory disorders such as diabetes mellitus. Arterial calcification is associated with significant morbidity and increased early mortality. Vascular calcification is a highly orchestrated process that entrains a repertoire of transcription factors and involves the activation of an osteogenic program that recapitulates the molecular fingerprints seen in bone formation. Recent studies have implicated the inflammatory cytokine tumor necrosis factor alpha in the pathobiology of arterial calcification. Metabolic acidosis, which is prevalent in patients with advanced kidney disease, has also been shown in some recent studies to attenuate vascular calcification in animal models. In this review, we summarize the recent advances in understanding the molecular mechanisms underpinning vascular mineralization and discuss their implications in terms of translational opportunities, unmet needs, and future directions.