[Chronic kidney disease and atherosclerosis]

Area of Science:

• Nephrology
• Cardiology
• Pathology

Context:

• Cardiovascular disease (CVD) is a primary cause of mortality in patients with chronic kidney disease (CKD), especially those with end-stage renal disease (ESRD).
• ESRD patients exhibit distinct pathological vascular changes, including intimal atherosclerosis and medial calcific sclerosis.
• Key risk factors for CVD in ESRD include hypertension, dyslipidemia, and chronic kidney disease-mineral bone disorder (CKD-MBD).

Purpose:

• To review the pathological features of atherosclerosis in CKD and ESRD patients.
• To discuss the significant risk factors contributing to cardiovascular mortality in this population.
• To explore current and potential therapeutic strategies for managing atherosclerosis and associated risk factors in CKD and ESRD.

Summary:

• Atherosclerosis is prevalent in CKD, with intimal and medial vascular changes prominent in ESRD.
• Hypertension, dyslipidemia, and CKD-MBD are critical contributors to CVD risk in ESRD.
• Management strategies include blood pressure control with renin-angiotensin system inhibitors, statin therapy for dyslipidemia, and agents like active vitamin D and sevelamer to inhibit vascular calcification.

Impact:

• Highlights the critical link between CKD progression and cardiovascular complications.
• Emphasizes the multifactorial nature of CVD risk in ESRD patients.
• Provides insights into therapeutic targets for mitigating cardiovascular events in CKD and ESRD populations.