[Cardiovascular disease in terminal end-stage renal failure--epidemiological aspects]

Cardiovascular disease is the leading cause of death in patients with ESRF. Cardiovascular mortality is 10- to 30-fold higher in ESRF patients than in the general population after adjustment for age, gender, ethnic origin and diabetes. Left ventricle hypertrophy, heart failure, and arterial atheroma are the main causes of cardiovascular morbidity-mortality. Among the classical cardiovascular risk factors identified in the Framingham study, only male gender, Caucasian ethnic origin, diabetes, and smoking are found in dialysis patients. Systolic blood pressure and total cholesterol are not associated with cardiovascular morbidity-mortality in the dialysis population. Inversely, low systolic pressure and serum cholesterol are risk factors for death. Since the classical risk factors are insufficient to explain the high cardiovascular morbidity-mortality in the dialysis population, factors related to CRF and its treatment have been proposed. These factors include hydroelectrolytic disorders, anemia, elevated Lp(a) and homocysteine, a state of micro-inflammation, and elevated thrombogenesis factors. Strategies designed to identify and prevent cardiovascular risk factors in the dialysis population should take into consideration the classical risk factors as well as specific risk factors related to CRF, and this well before reaching the state of ESRF.