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Updated: Aug 12, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
[Cardiovascular risk in patients with chronic renal failure. Patients in renal replacement therapy]
A Cases1, M Vera, J M López Gómez
1Servicio de Nefrología, Unidad de Hipertensión Arterial, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona. acases@medicina.ub.es
Insights
Dialysis patients face a significantly higher risk of cardiovascular disease due to traditional factors and uremia-specific issues. Early, aggressive, and multifactorial management of these cardiovascular risk factors is crucial to reduce mortality.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Context:
- Dialysis patients have a 10-20 times higher cardiovascular mortality rate than the general population.
- Cardiovascular disease in dialysis patients is not fully explained by classical risk factors alone.
- Uremic patients exhibit endothelial dysfunction even before initiating dialysis.
Purpose:
- To highlight the elevated cardiovascular disease (CVD) risk in dialysis patients.
- To identify both traditional and novel cardiovascular risk factors contributing to CVD in this population.
- To emphasize the role of uremia-related factors and endothelial dysfunction in CVD development.
Summary:
- Cardiovascular disease (CVD) is a leading cause of death in dialysis patients, with mortality rates 10-20 times higher than the general population.
- Beyond traditional risk factors, novel factors like hyperhomocysteinemia, inflammation, and uremia-specific issues (anemia, impaired calcium-phosphorus metabolism) contribute to CVD.
- Endothelial dysfunction, present before and worsened by dialysis, is a key initial event in atherosclerosis development.
Impact:
- Recognizing dialysis patients as a high-risk group for cardiovascular disease.
- Underscoring the need for early, aggressive, and multifactorial management of cardiovascular risk factors in dialysis patients.
- Aimed at reducing the high cardiovascular morbidity and mortality observed in this vulnerable population.
Abstract:
Dialysis patients constitute a high-risk subset of patients for developing cardiovascular disease, which accounts for nearly 50% of deaths. After stratification for age, race and gender, cardiovascular mortality is 10-20 times higher in dialysis patients than in the general population. Cardiovascular disease in this population cannot be fully explained by the high prevalence of classical cardiovascular risk factors (age, hypertension, diabetes, hyperlipidemia, smoking, etc.). Thus, the involvement of "new" cardiovascular risk factors (hyperhomocysteinemia, hyperfibrinogenemia, high lipoprotein (a) levels, oxidative stress, inflammation, etc.), and uremia-related factors (anemia, impaired calcium-phosphorus metabolism, hyperparathyroidism, accumulation of endogenous inhibitors of nitric oxide synthesis, etc.) has been also invoked to play a role in the increased cardiovascular risk in these patients. Endothelial dysfunction is the initial event in the development of atherosclerosis. Uremic patients exhibit an endothelial dysfunction, even before starting dialysis, which persists o is even aggravated under dialysis treatment. Uremic patients must be considered at high risk of developing cardiovascular disease. Thus cardiovascular risk factors in these patients should be managed early, aggressive and multifactorially in order to reduce their high cardiovascular morbidity and mortality.
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01:24Chronic Kidney Disease II: Clinical Manifestations
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