Early chronic kidney disease-mineral bone disorder stimulates vascular calcification

Yifu Fang, Charles Ginsberg, Toshifumi Sugatani, Marie Claude Monier-Faugere, Hartmut Malluche, Keith A. Hruska

Research output: Contribution to journalArticlepeer-review

162 Scopus citations


The chronic kidney disease-mineral and bone disorder (CKD-MBD) syndrome is an extremely important complication of kidney diseases. Here we tested whether CKD-MBD causes vascular calcification in early kidney failure by developing a mouse model of early CKD in a background of atherosclerosis-stimulated arterial calcification. CKD equivalent in glomerular filtration reduction to human CKD stage 2 stimulated early vascular calcification and inhibited the tissue expression of -klotho (klotho) in the aorta. In addition, osteoblast transition in the aorta was stimulated by early CKD as shown by the expression of the critical transcription factor Runx2. The ligand associated with the klotho-fibroblast growth factor receptor complex, FGF23, was found to be expressed in the vascular media of sham-operated mice. Its expression was decreased in early CKD. Increased circulating levels of the osteocyte-secreted proteins, FGF23, and sclerostin may have been related to increased circulating klotho levels. Finally, we observed low-turnover bone disease with a reduction in bone formation rates more than bone resorption. Thus, the CKD-MBD, characterized by cardiovascular risk factors, vascular calcification, increased circulating klotho, FGF23 and sclerostin levels, and low-turnover renal osteodystrophy, was established in early CKD. Early CKD caused a reduction of vascular klotho, stimulated vascular osteoblastic transition, increased osteocytic secreted proteins, and inhibited skeletal modeling producing the CKD-MBD

Original languageEnglish
Pages (from-to)142-150
Number of pages9
JournalKidney International
Issue number1
StatePublished - Jan 2014

Bibliographical note

Funding Information:
KAH reports having received research funding from Fresenius, Shire, Celgene, and Amgen. HM reports having received funding from Shire and Fresenius. KAH and HM have been consultants for Shire and Fresenius. All the other authors declared no competing interests.

Funding Information:
This research was supported by NIH grants DK070790 (to KAH) and DK089137 (to KAH), by an investigator-stimulated trial grant from Fresenius, and by the Kentucky Nephrology Research Trust.


  • FGF23
  • a-klotho
  • vascular calcification

ASJC Scopus subject areas

  • Nephrology


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