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Atherosclerosis in chronic renal failure
D I Charney1, D F Walton, A K Cheung
1University of Utah, Salt Lake City.
Insights
Atherosclerosis is a major concern for patients with chronic kidney disease. This review examines whether kidney failure accelerates cardiovascular disease and identifies contributing factors in uremic patients.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Pathology
Background:
- Atherosclerotic cardiovascular disease is a leading cause of death in patients with chronic renal failure.
- The incidence and rate of atherosclerosis in chronic renal failure patients compared to the general population remain unclear.
- The precise nature of atherosclerotic lesions in chronic renal failure is not well-defined.
Purpose of the Study:
- To review the pathology of atherosclerotic lesions in chronic renal failure.
- To explore factors contributing to atherogenesis in uremic patients.
- To evaluate evidence for accelerated atherosclerosis in end-stage renal disease.
Main Methods:
- Literature review of existing studies on atherosclerosis in chronic renal failure.
- Discussion of pathological findings and contributing factors.
- Analysis of data comparing atherosclerosis rates in uremic versus non-uremic populations.
Main Results:
- Chronic renal failure is associated with significant cardiovascular morbidity and mortality.
- The uremic state, dialysis, and other factors may contribute to atherogenesis.
- Evidence suggests atherosclerosis may be accelerated in patients with end-stage renal disease.
Conclusions:
- Further research is needed to clarify the incidence and progression of atherosclerosis in chronic renal failure.
- Identifying and mitigating risk factors for accelerated atherosclerosis is crucial for improving outcomes in uremic patients.
- Understanding the specific role of the uremic milieu in atherogenesis is essential.
Abstract:
Atherosclerotic cardiovascular disease is a significant cause of morbidity and mortality in patients with chronic renal failure. It is unclear, however, if atherosclerosis in fact occurs at a higher incidence compared with the nonuremic population matched for age, hypertension, and diabetes mellitus or if it occurs at an accelerated rate following the onset of end-stage renal disease. The extent of true atherosclerotic lesions, versus clinically diagnosed "atherosclerosis," in patients with chronic renal failure is equally unclear. Potentially, the uremic state per se, the dialysis treatment, and factors unrelated to renal failure may participate in atherogenesis. The relative contribution of each of these factors is unknown. In this review, we discuss the pathology of "atherosclerotic" lesions in patients with chronic renal failure and the putative factors involved in atherogenesis in this population and describe the results of available studies examining the issue of accelerated atherosclerosis in uremia.