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Uraemic vasculopathy in children with chronic kidney disease: prevention or damage limitation?

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Abstract

Since the inception of pediatric dialysis programmes nearly 50 years ago, there have been vast improvements in both the technology and expertise in the care of children with chronic kidney disease (CKD). Nevertheless, children on dialysis continue to have a significantly higher mortality than their healthy peers and cardiovascular disease (CVD) is the most common cause of death in this group. Chronic kidney disease is described as the “perfect storm” of risk factors for CVD development, and vascular calcification is a highly regulated cell-mediated process with several promoters and inhibitors of calcification. CVD begins early in the course of CKD and there is an independent and graded association between cardiovascular morbidity and renal decline. Also, it is shown that once vascular damage and calcification begin, they progress inexorably in the uraemic milieu and may only be partially reversed after successful transplantation. Thus, preventing the development of CVD is key, and early identification and management of specific CVD-related risk factors should begin from the early stages of CKD. While the vasculopathy of childhood CKD is clearly multifactorial, clinical, epidemiological and cell biology studies provide converging evidence pointing to the role of dysregulated mineral metabolism as an important modifiable risk factor in the development of vascular calcification. In this review we focus on the role of calcium, phosphate, parathyroid hormone and vitamin D in ectopic vascular calcification, and discuss the role of screening, early intervention and management of established vascular calcification.

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Authors and Affiliations

  1. Department of Nephrourology, Great Ormond Street Hospital for Children, NHS Trust, Great Ormond Street, London, WC1N 3JH, United Kingdom

    Rukshana Shroff & Catherine Quinlan

  2. Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Mark Mitsnefes

Authors
  1. Rukshana Shroff
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  2. Catherine Quinlan
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  3. Mark Mitsnefes
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Correspondence to Rukshana Shroff.

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Shroff, R., Quinlan, C. & Mitsnefes, M. Uraemic vasculopathy in children with chronic kidney disease: prevention or damage limitation?. Pediatr Nephrol 26, 853–865 (2011). https://doi.org/10.1007/s00467-010-1691-y

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  • DOI: https://doi.org/10.1007/s00467-010-1691-y

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