Fig. 4From: Impact of vascular calcification on cardiovascular mortality in hemodialysis patients: clinical significance, mechanisms and possible strategies for treatmentCellular aspect of VSMCs leading to medial calcification. Elevated P induces Runx2 upregulation and promoted osteochondrocytic differentiation of VSMCs. At the same time, uremic milieu decreases endogenous inhibitors. Hyperphosphatemia stimulated excretion of extracellular matrix with high affinity for calcium from VSMCs. Concomitant calcium overload (or elevated calcium) enhances calcium deposition around VSMCs. Abbreviations: VSMC vascular smooth muscle cell, P phosphate, Ca calcium, MGP matrix Gla protein, ECM extracellular matrixBack to article page