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Reviews in Cardiovascular Medicine  2020, Vol. 21 Issue (2): 157-162     DOI: 10.31083/j.rcm.2020.02.99
Special Issue: Cardiovascular disorders in chronic kidney disease
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Accelerated and intensified calcific atherosclerosis and microvascular dysfunction in patients with chronic kidney disease
Meer Fakhry1, Mandeep S. Sidhu2, Sripal Bangalore3, Roy O. Mathew1, 4, *()
1Department of Medicine, University of South Carolina School of Medicine, Columbia, SC 29208, USA
2Department of Medicine, Division of Cardiology, Albany Medical College, Albany, NY 12208, USA
3Department of Medicine, Division of Cardiology, NYU Grossman School of Medicine, New York, NY 10016, USA
4Department of Medicine, Division of Nephrology, Columbia VA Health Care System, Columbia SC 29209, USA
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Cardiovascular disease, and in particular coronary artery disease (CAD), remains an important contributor of morbidity and mortality among patients with chronic kidney disease (CKD). Classic symptomatology of CAD and effectiveness of established therapeutic measures is less frequent in patients with CKD. This suggests unique characteristics of CAD among patients with CKD. Two important features of CAD in CKD include increased calcific density of atherosclerotic plaques and of the vessels themselves (coronary artery calcification –– CAC), as well as a decrease in microcirculatory function –– or coronary microcirculatory dysfunction. A multitude of pathophysiologic pathways have been identified that contribute to CAC in CKD; less is known about the pathophysiology of microcirculatory dysfunction. It is not well established if these two processes are directly related to each other, but the combination results in a greater severity of effect on overall myocardial function and may in part explain the greater preponderance of silent myocardial infarction. Further investigation is needed to better understand these unique aspects of CAD in CKD as well as the role they play in overall CVD in this group, and ultimately therapeutics that may lessen the burden of disease.
Key words:  Chronic kidney disease      end stage renal disease      dialysis      coronary artery disease      coronary artery calcification      coronary microvascular dysfunction     
Submitted:  21 May 2020      Revised:  28 May 2020      Accepted:  02 June 2020      Published:  30 June 2020     
*Corresponding Author(s):  Roy O. Mathew     E-mail:

Cite this article: 

Meer Fakhry, Mandeep S. Sidhu, Sripal Bangalore, Roy O. Mathew. Accelerated and intensified calcific atherosclerosis and microvascular dysfunction in patients with chronic kidney disease. Reviews in Cardiovascular Medicine, 2020, 21(2): 157-162.

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