Hypertension and accelerated atherosclerosis in endstage renal disease

In patients with chronic renal failure cardiovascular morbidity and mortality are higher than in non-uremic controls. Chronic renal failure influences a number of factors that promote atherogenesis: blood pressure, nitric oxide activity, advanced glycosylation, lipid metabolism, oxidant stress, homocysteine levels, glucose metabolism and PTH. How these factors are influenced by chronic renal failure, how they interrelate and how they promote atherogenesis is still debated. Published data are for and against accelerated atherogenesis. The use of only clinical endpoints may be partially responsible for these conflicting data. Measurement of atherosclerosis itself by computerized ultrasound imaging of the common carotid arteries can be used as an outcome variable. We conclude that there is still a need for prospective, controlled, epidemiologic studies to answer the question whether or not atherogenesis is accelerated in chronic renal failure and to clarify the role of hypertension and other risk factors.