[Cardiovascular events in chronic advanced renal insufficiency. Current concepts]

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.