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Cardiovascular Events in Hemodialysis Patients: Challenging against Vascular Calcification
1Hemodialysis Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.
Insights
Cardiovascular disease is a major risk for hemodialysis patients due to early polyvascular disease in chronic kidney disease (CKD). Early detection and treatment of vascular calcification are crucial for better outcomes.
Area of Science:
- Nephrology
- Cardiology
- Vascular Surgery
Background:
- Patients with chronic kidney disease (CKD) exhibit high cardiovascular mortality, particularly those undergoing hemodialysis.
- Polyvascular diseases manifest early in CKD, linked to insulin resistance, nitric oxide (NO)/endothelin imbalance, and oxidative stress.
- Understanding vascular calcification pathophysiology is critical for improving outcomes in CKD patients.
Purpose of the Study:
- To review cardiovascular disease in CKD patients, focusing on polyvascular disease clinical aspects.
- To emphasize early detection of microcirculatory impairment.
- To highlight the importance of eradicating vascular calcification before renal replacement therapy.
Main Methods:
- Literature review focusing on cardiovascular disease in CKD.
- Analysis of pathophysiological mechanisms including insulin resistance, NO bioavailability, and oxidative stress.
- Clinical review of polyvascular disease manifestations in CKD patients.
Main Results:
- Cardiovascular mortality is significantly elevated in hemodialysis patients.
- Polyvascular disease is an early complication of CKD.
- Pathophysiological factors contribute to vascular calcification in CKD.
Conclusions:
- Early detection and intervention for microcirculatory impairment and vascular calcification are essential in CKD patients.
- Addressing polyvascular disease is key to reducing cardiovascular mortality in CKD.
- Proactive management before renal replacement therapy can improve patient outcomes.
Abstract:
Particularly in patients with hemodialysis, cardiovascular mortality rate is extremely high. Polyvascular diseases develop at an early stage of chronic kidney disease (CKD). Pathophysiology includes insulin resistance and/or imbalance between nitric oxide (NO) and endothelin bioavailability as well as oxidative stress. The understanding in pathophysiology of vascular calcification and strategic treatment is a critical issue to achieve favorable outcome for the patients with CKD. In this article, we aim to review the cardiovascular disease for the patients with CKD with a particular emphasis on the clinical aspects of polyvascular disease. Finally, we address to detect microcirculatory impairment and eradicate vascular calcification as early as possible prior to renal replacement therapy. (This is a translation of Jpn J Vasc Surg 2016; 25: 359-365.).