Chronic renal failure: a cardiovascular risk factor.

Area of Science:

• Nephrology
• Cardiology
• Internal Medicine

Background:

• Patients undergoing renal replacement therapy have a substantially elevated risk of cardiovascular disease (CVD) morbidity and mortality compared to the general population.
• Subtle declines in renal function, indicated by reduced glomerular filtration rate and albuminuria, are recognized as significant CVD risk factors.
• Traditional risk factors inadequately explain the heightened CVD risk in patients with kidney disease, necessitating the exploration of additional known and emerging factors.

Purpose of the Study:

• To review known and emerging factors contributing to increased cardiovascular risk in patients with renal disease.
• To highlight the importance of early identification of renal failure for cardiovascular risk management.

Main Methods:

• Review of existing literature on cardiovascular risk factors in patients with renal disease.
• Discussion of specific pathophysiological mechanisms linking renal disease to CVD.

Main Results:

• Hyperphosphatemia and elevated calcium-phosphorous product contribute to cardiovascular calcification.
• Anemia is linked to left ventricular hypertrophy.
• Accelerated atherogenesis, oxidative stress, and a microinflammatory state due to endothelial dysfunction are consequences of renal disease.
• Other contributing factors include hyperhomocysteinemia, increased sympathetic nervous system activity, altered lipoproteins (e.g., elevated lipoprotein A), and increased asymmetrical dimethyl-arginine.

Conclusions:

• Patients with renal disease are at high risk for cardiovascular disease and should be considered candidates for secondary prevention.
• Early identification of often-undetected renal failure is paramount for effective cardiovascular risk management.