Vitamin D, Phosphate and Vasculotoxicity

Abstract

Vascular calcification is a complex process that is formed by the ectopic deposition of calcium-phosphate hydroxyapatite. Medial and intimal vascular calcification is frequently present in patients with diabetes mellitus and chronic kidney disease (CKD) which markedly increases the morbidity and mortality of these patients. Increased serum calcium and phosphate levels, along with the use of active vitamin D metabolites, are commonly believed to be related to the evolvement of vascular wall mineralization in CKD patients. Because CKD patients have lower serum levels of vitamin D, they are routinely prescribed with vitamin D supplements which exert a dualistic role that is both healthful and harmful in these patients, perhaps protecting bone health, at the expense of promoting vascular pathology. This brief article explains how reducing phosphate burden in CKD patients could minimize vitamin D-associated vascular wall calcification.