How to reconcile conventional and altered risk factor patterns in dialysis patients

Epidemiological relationships between risk factors and outcome in patients with chronic kidney failure (CKF), including individuals with end-stage kidney failure, can be categorized into three types: risk factor relationships that are similar to those observed in the general population; risk factor relationships that differ from those observed in the general population; and risk factor patterns that are difficult or not possible to compare to the general population, possibly because such risk factors have not been studied or are not capable of being studied in normal individuals. These latter risk factor patterns may or may not be different from what might commonly be anticipated. It is recommended that risk factor relationships in CKF patients which differ from those observed in the general population should be referred to as altered risk factor patterns (ARFPs). The causes for ARFPs include protein-energy wasting and inflammatory disorders, which occur commonly in patients with CKF. Epidemiological and other evidence is presented suggesting that the ARFPs may also have other causes. Since ARFPs are common in CKF, it is important to understand the causes and appropriate therapeutic goals concerning these risk factors. Studies, including interventional clinical trials, are indicated to ascertain the causes of ARFPs and the therapeutic targets for these risk factors for individuals with chronic kidney disease and CKF.