Genesis of atherosclerosis in uremic patients

Atherosclerosis significantly contributes to the high incidence of cardiovascular complications and death of uremic patients. Whereas some of the mechanisms that are being discussed in the atherogenesis of chronic renal failure are well established, many others remain hypothetical at present. One of the main reasons is that no long-term, well-controlled studies are available in this area which would have systematically tested the importance of factors such as high blood pressure, via the use of antihypertensive drugs, or disturbances of lipoprotein metabolism, via the use of lipid-lowering medications. Current clinical practice as to the use of the latter has been extensively reviewed in a recent meta-analysis by Massy et al. [69]. The majority of studies have been limited to relating hemodynamic or metabolic parameters to parameters of ischemia. Controlled long-term studies are required to reach valid conclusions on the implications of the numerous factors which theoretically may play a role in the atherosclerotic complications of chronic renal failure patients.