Background: Patients affected by Chronic Kidney Disease and Mineral Bone Disorder
(CKD-MBD) have a high risk of cardiovascular (CV) mortality that is poorly explained by traditional
risk factors. The newest medical treatments for CKD-MBD have been associated with encouraging, but
still inconsistent, improvement in CV disease complications and patient survival. A better understanding
of the biomarkers and mechanisms of left ventricular hypertrophy (LVH), atherosclerosis, and vascular
calcification (VC) may help with diagnosis and treatment of the organ damage that occurs secondary to
CKD-MBD, thus improving survival. Recent insights about fibroblast growth factor-23 (FGF23) and its
co-receptor, Klotho, have led to marked advancement in interpreting data on vascular aging and CKDMBD.
Conclusion: This review will discuss the current experimental and clinical evidence regarding FGF23
and Klotho, with a particular focus on their roles in LVH, atherosclerosis, and VC.