Vascular Pseudo-Ossification rather than“Vascular Calcification” – A New Term for anOld Phenomenon in Chronic Kidney Disease:Perspective and New Opinion

The current paper is a Perspective & New Opinion article that offers the term “Vascular pseudo-ossification” as a new term for “vascular calcification” phenomenon in chronic kidney disease (CKD). Vascular calcification is a well-documented complication of CKD. Patients with CKD develop extensive medial calcification, which causes increased arterial stiffness that represents an independent predictor of increased morbidity and mortality due to cardiovascular events. Vascular calcification (VC), in which vascular smooth muscle cells (VSMCs) undergo a phenotypic transformation into osteoblast-like cells, is one of the emergent risk factors for the accelerated atherosclerosis process characteristic of chronic kidney disease (CKD). Until recently, the accepted concept was that vascular calcification in CKD is a passive process of dystrophic calcification that serves as the end stage of degenerative vascular disease. However, the recent accumulation of data indicates that it is an actively regulated process which bears many similarities to bone formation. The vascular smooth muscle cells can undergo trans-differentiation into osteoblast-like cells by losing characteristic smooth muscle markers subsequently with up-regulation of osteoblastic and bone specific markers and then become calcified similarly to bone formation. Considering the differences between dystrophic calcification and the process of vascular calcification in CKD, concurrently with its close resemblance to ossification, we suggest that the pathophysiological process that culminates in the deposition of calcium in arterial intima should rightfully be designated “Pseudo-ossification” rather than “calcification”.