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Moderator's view: treatment of vascular calcification is a physical impossibility, so far.

stability and as such contribute to the disproportionally high incidence of sudden death in CKD. As in burn victims, where initial morbidity is driven by acute skin injury and infection but late long-lasting invalidating complications arise from rigid scar tissue, arterial calcification, initially ignited by disturbed mineral metabolism and inflammation, has severe cardiovascular consequences on its own. Zoccali and co-workers argue that cardiovascular calcification is not an appropriate target of therapy based on the discrepant findings of intervention studies, since clinical studies did demonstrate attenuated progression of vascular calcification but not improved survival. However, methodological limitations and flaws should be considered a more plausible explanation for this discrepancy. The interplay between genetic and environmental factors dictates whether cardiovascular calcification will occur or not. Despite its limitations (costs, radiation exposure and low sensitivity), screening for vascular and cardiac valve calcification may allow to identify individuals at risk for premature cardiovascular complications. Since progression of cardiovascular calcification may worsen with inappropriate treatments and it has been shown to be manageable with current tailored therapeutic options, nihilism is not an option. This will require a multifaceted approach in which the control of both mineral metabolism and inflammation are prominent targets. Despite the current lack of hard end point studies supporting this thesis, it should keep in mind that the absence of evidence is not evidence of absence.