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[Cardiovascular events in chronic advanced renal insufficiency. Current concepts]
1Divisione Nefrologica e Centro di Fisiologia Clinica del C.N.R, Reggio Calabria.
Insights
Patients with end-stage renal disease have high cardiovascular disease and mortality risks. Managing hypertension, anemia, and smoking are key interventions to reduce these risks in dialysis patients.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- End-stage renal disease (ESRD) patients exhibit elevated risks of cardiovascular disease (CVD) and mortality.
- Key contributing factors include arterial hypertension, diabetes, smoking, anemia, hyperparathyroidism, hyperhomocysteinemia, and disordered lipid metabolism.
- Emerging factors include inflammation, sympathetic activity, and asymmetric dimethylarginine (ADMA).
Purpose of the Study:
- To review the cardiovascular risk factors in patients with end-stage renal disease.
- To highlight the role of traditional and novel risk factors in dialysis patients.
- To discuss potential intervention strategies for reducing cardiovascular mortality.
Main Methods:
- Literature review of established and emerging cardiovascular risk factors in ESRD patients.
- Analysis of the impact of uremic state on specific metabolic and physiological parameters.
- Discussion of current and future therapeutic interventions.
Main Results:
- Hypertension and diabetes are highly prevalent and significant contributors to mortality and morbidity in dialysis patients.
- Uremic milieu alters factors like parathyroid hormone, homocysteine, and lipids.
- Inflammation, sympathetic overactivity, ADMA, and sleep apnea are increasingly recognized as critical CVD risk factors.
Conclusions:
- Effective management of hypertension, anemia, and smoking cessation are crucial interventions.
- Future strategies may involve controlling inflammation, sympathetic activity, and endothelial dysfunction.
- These interventions aim to significantly reduce the high cardiovascular mortality observed in chronic dialysis patients.
Abstract:
Patients with end-stage renal disease face a particularly high risk of cardiovascular disease and total mortality. Part of their increased risk is due to higher prevalence of established risk factors such as arterial hypertension, diabetes, smoking and anemia. Hypertension and diabetes have a very high prevalence in dialysis patients and play a major role in their high mortality and morbidity. Hyperparathyroidism, hyperhomocis-teinemia and disordered lipid metabolism represent factors which are peculiarly altered by the uremic state. Inflammatory processes, high sympathetic activity and the accumulation of an endogenous inhibitor of NO synthase (ADMA) have recently emerged as cardiovascular risk factors of paramount importance. Sleep apnea has been linked with nocturnal hypertension and could be implicated in the high prevalence of concentric hypertrophy of the left ventricle in these patients. Hypertension control as well as appropriate treatment of anaemia and cessation of smoking constitute fundamental areas of intervention in dialysis patients. It is possible that in the near future control of chronic inflammatory processes, of high sympathetic activity and endothelial dysfunction will further contribute to curb the exceedingly high cardiovascular mortality of patients on chronic dialysis treatment.