*Review* **Cardiovascular Calcification in Chronic Kidney Disease—Therapeutic Opportunities**

### **Anika Himmelsbach** †**, Carina Ciliox** † **and Claudia Goettsch \***

Department of Internal Medicine I, Cardiology, Medical Faculty, RWTH, Aachen University,

52074 Aachen, Germany; ahimmelsbach@ukaachen.de (A.H.); cciliox@ukaachen.de (C.C.)

**\*** Correspondence: cgoettsch@ukaachen.de; Tel.: +49-241-80-37312

† A.H. and C.C. contributed equally.

Received: 25 February 2020; Accepted: 12 March 2020; Published: 14 March 2020

**Abstract:** Patients with chronic kidney disease (CKD) are highly susceptible to cardiovascular (CV) complications, thus suffering from clinical manifestations such as heart failure and stroke. CV calcification greatly contributes to the increased CV risk in CKD patients. However, no clinically viable therapies towards treatment and prevention of CV calcification or early biomarkers have been approved to date, which is largely attributed to the asymptomatic progression of calcification and the dearth of high-resolution imaging techniques to detect early calcification prior to the 'point of no return'. Clearly, new intervention and managemen<sup>t</sup> strategies are essential to reduce CV risk factors in CKD patients. In experimental rodent models, novel promising therapeutic interventions demonstrate decreased CKD-induced calcification and prevent CV complications. Potential diagnostic markers such as the serum T50 assay, which demonstrates an association of serum calcification propensity with all-cause mortality and CV death in CKD patients, have been developed. This review provides an overview of the latest observations and evaluates the potential of these new interventions in relation to CV calcification in CKD patients. To this end, potential therapeutics have been analyzed, and their properties compared via experimental rodent models, human clinical trials, and meta-analyses.

**Keywords:** chronic kidney disease; cardiovascular disease; vascular calcification; experimental rodent models

**Key Contribution:** This work provides a comprehensive overview of therapeutic opportunities to combat cardiovascular (CV) calcification in chronic kidney disease (CKD). Novel potential therapeutic approaches have been compared and evaluated in human clinical trials and meta-analyses as well as in experimental rodent models of CV calcification in CKD.
