ウレミア関連心血管疾患の疫学とメカニズム
Marcello Tonelli1, S Ananth Karumanchi2, Ravi Thadhani2
1From Department of Medicine, University of Calgary, AB, Canada (M.T.); Department of Medicine and Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, and Howard Hughes Medical Institute, Chevy Chase, MD (S.A.K..); and Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston (R.T.). tonelli.admin@ucalgary.ca.
Circulation
|February 3, 2016
まとめ
慢性腎疾患 (CKD) の患者は,心血管疾患 (CVD) のリスクが著しく高い. 伝統的なリスクを超えて,尿病に特有の要因が,CKD患者におけるCVDを誘発し,標的型の研究と改善された管理戦略を必要とします.
科学分野:
- 腎臓科
- 心臓病科
- 流行病学について
背景:
- 慢性腎臓病 (CKD) や末期腎臓病 (ESRD) の患者は,同年齢の患者と比較して,心血管疾患 (CVD) のリスクが5~10倍高い.
- この集団におけるCVDは冠動脈疾患,不律性,脳卒中,充血性心不全で表れます.
- 糖尿病や高血圧のような伝統的なリスク要因は,CVDの病原性における毒素の蓄積による尿性特異的要因によって悪化します.
研究 の 目的:
- 慢性腎臓病の患者における従来の心血管疾患と尿血症に関連する心血管疾患の流行病学を見直す.
- ウレミア特有のCVD病原性の仮定されたメカニズムを探求する.
- 慢性腎臓病患者の現在のCVD診断と治療におけるギャップを特定し,将来の研究方向性を提案する.
主な方法:
- CKDにおけるCVDに関する疫学研究の文献レビュー.
- 尿血症とCVDを関連付ける推論されたメカニズムの分析.
- 慢性腎臓病管理の背景にある現在および新興のCVD診断と治療法の評価
主要な成果:
- CKDとESRDはCVDのリスクを大幅に高めています.
- これらの患者の心血管疾患発症には,尿病特有の要因が重要な役割を果たします.
- 増加するCKD集団におけるCVDの医学的管理には大きなギャップがあります.
結論:
- CKD患者の心血管疾患の管理におけるギャップを埋めるには,標的型の疫学および翻訳研究が不可欠です.
- ウレミア関連のCVDの認識と管理に関する世界的な課題は,先進国と途上国の両方に注意が必要です.
- CKDにおける効果的なCVD管理には,従来のおよび尿病特有の要因の理解を統合した包括的なアプローチが必要である.
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