Translational Nephrology Calcification and the usual suspect phosphate: still guilty

In patients with renal failure, the high prevalence of vascular, valvular and soft-tissue calcifications and their consequences for cardiovascular outcomes have recently received much attention. Several studies documented that the calcification burden is associated with increased morbidity and mortality in uraemia. In vitro and in vivo research has demonstrated that tissue calcification is not just based on passive calcium and phosphate precipitation, but that active cellular processes such as osteogenic differentiation of vascular smooth muscle cells (VSMC) are involved and that a number of local and systemic calcium-regulatory factors control and prevent unwanted extra-osseous calcification. An important finding was the new under-standing that calcium and phosphate are immediat