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Updated: Aug 29, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Novel cardiovascular risk factors in end-stage renal disease
Carmine Zoccali1, Francesca Mallamaci, Giovanni Tripepi
1CNR-IBIM, Epidemiologia Clinica e Fisiopatologia delle malattie Renali e dell'Ipertensione Arteriosa, Reggio Calabria, Italy. carmine.zoccali@tin.it
Insights
In end-stage renal disease (ESRD), traditional factors don't fully explain cardiovascular risks. Asymmetric dimethylarginine (ADMA) significantly increases mortality and cardiovascular events in dialysis patients.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Biochemistry
Background:
- Traditional risk factors inadequately explain cardiovascular disease (CVD) disparities in chronic kidney disease (CKD) patients.
- While hyperphosphatemia and calcium-phosphate product are CVD risk factors, inflammation may be a stronger trigger for vascular calcification.
- Other potential factors like homocysteine and Chlamydia pneumoniae lack strong direct evidence in ESRD cardiovascular mortality.
Purpose of the Study:
- To investigate the role of non-traditional risk factors in cardiovascular events and mortality among patients with chronic nephropathies, particularly end-stage renal disease (ESRD).
- To evaluate the contribution of oxidative stress and asymmetric dimethylarginine (ADMA) to adverse cardiovascular outcomes in dialysis patients.
Main Methods:
- Review and analysis of existing literature on risk factors for cardiovascular disease in patients with chronic kidney disease and ESRD.
- Examination of the association between metabolic derangements (hyperphosphatemia, calcium-phosphate product), inflammation, homocysteine, Chlamydia pneumoniae, oxidative stress, and ADMA with cardiovascular outcomes.
Main Results:
- Uncontrolled hyperphosphatemia and high calcium-phosphate product are risk factors for cardiovascular calcification and ischemia.
- Inflammation appears to be a more significant trigger for vascular calcification than metabolic factors.
- Raised plasma ADMA, linked to oxidative stress in ESRD, independently increases the risk of death (52%) and cardiovascular events (34%) in dialysis patients.
Conclusions:
- Non-traditional risk factors, particularly ADMA, play a crucial role in the high cardiovascular mortality observed in ESRD patients.
- Oxidative stress and elevated ADMA levels are significant contributors to adverse cardiovascular outcomes in dialysis populations.
- Further research into managing ADMA and oxidative stress may mitigate cardiovascular risks in CKD and ESRD.
Abstract:
Traditional risk factors only in part explain the risk differential between the general population and the population of patients with chronic nephropathies. Uncontrolled hyperphosphatemia and high calcium phosphate product constitute risk factors for cardiovascular calcifications, cardiac ischemia, and adverse cardiovascular outcomes, yet inflammation may be an even more important trigger of vascular calcification than these metabolic derangements. Homocysteine predicts cardiovascular events in ESRD, but evidence that this sulfur amino acid is directly implicated in the high cardiovascular mortality of uremic patients is still lacking. It seems unlikely that Chlamydia pneumoniae is a major risk factor in dialysis patients because the association between anti-Chlamydia antibodies and incident cardiovascular events seems to depend largely on the confounding effect of some traditional risk factors. Oxidative stress and raised plasma concentration of asymmetric dimethylarginine (ADMA) are pervasive in ESRD, and high ADMA in these patients may be at least in part the expression of the high rate of generation of oxidants. ADMA per se seems responsible for a 52% increase in the risk of death and for a 34% increase in the risk of cardiovascular events in dialysis patients.
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