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Epidemiology of vascular disease in renal failure
1Department of Medicine, Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN 37232-2372, USA. alp.ikizler@mcmail.vanderbilt.edu
Insights
Cardiovascular disease (CVD) is a major cause of death in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. Chronic inflammation may accelerate atherosclerosis in these patients, necessitating new strategies to reduce CVD mortality.
Area of Science:
- Nephrology
- Cardiology
- Immunology
Background:
- Cardiovascular disease (CVD) is the primary cause of mortality in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD).
- CVD development in CKD/ESRD patients likely initiates before end-stage renal disease, influenced by both traditional and nontraditional risk factors associated with uremia.
- Chronic inflammation is increasingly recognized as a significant contributor to atherosclerosis and myocardial infarction.
Purpose of the Study:
- To investigate the role of chronic inflammation in the accelerated atherosclerosis observed in CKD and ESRD patients.
- To highlight the high prevalence of both chronic inflammation and CVD in ESRD populations.
- To emphasize the need for novel strategies to mitigate cardiovascular morbidity and mortality in ESRD patients.
Main Methods:
- Literature review and synthesis of current research on CVD, CKD, ESRD, and inflammation.
- Analysis of the interplay between uremic toxins, inflammation, and cardiovascular pathology.
- Examination of epidemiological data linking inflammation markers to CVD outcomes in renal disease.
Main Results:
- Nontraditional risk factors, particularly those linked to uremia and chronic inflammation, are significant drivers of CVD in CKD/ESRD patients.
- Chronic inflammation is highly prevalent in ESRD and is a probable causative factor for accelerated atherosclerosis.
- Accelerated atherosclerosis in CKD/ESRD patients is strongly associated with chronic inflammatory processes.
Conclusions:
- Chronic inflammation is a key factor in the pathogenesis of accelerated atherosclerosis and high CVD rates in CKD and ESRD patients.
- Addressing chronic inflammation is crucial for developing effective interventions to reduce cardiovascular mortality in ESRD.
- New therapeutic approaches targeting inflammation are essential for improving outcomes in patients with advanced kidney disease.
Abstract:
Cardiovascular disease (CVD) is the leading cause of death in the general population and a major cause of morbidity and mortality chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. The high prevalence of CVD in incident dialysis populations suggests that CVD begins during or before the stage of chronic renal insufficiency. While traditional risk factors observed in the general population may play a role in the progression of CVD in CKD and ESRD patients, the presence of several nontraditional factors related to the extent of uremia seems to be the more significant feature of CVD in this patient population. Recently, there have been significant advances in our understanding of how inflammation contributes to the pathogenesis of atherosclerosis and myocardial infarction. The fact that chronic inflammation and CVD are highly prevalent in ESRD patients, it is probable that chronic inflammation may be a causative factor for accelerated atherosclerosis observed in CKD and ESRD patients. Given the extent of the problem, efforts to lower the mortality rate among ESRD patients will require new approaches to reduce and/or prevent cardiovascular morbidity and mortality.