Atherogenesis in Renal Patients: A Model of Vascular Disease?

Abstract

Chronic kidney disease (CKD), and particularly kidney failure, is associated with accelerated atherosclerosis and approximately a 20-fold increased risk of cardiovascular death. The majority of these patients die from complications directly attributed to atherosclerosis and their life expectancy is decreased. Established risk factors are involved in the pathogenesis of this phenomenon. Age, gender, smoking, hypertension, dyslipidaemia and diabetes mellitus are among the established risk factors. Inflammation, qualitative lipid disorders (e.g. small dense low density lipoprotein), vascular calcification and oxidative stress represent emerging risk factors. The precise mechanism of atherosclerosis in patients with kidney failure is not yet known. CKD might represent a clinical model of atherogenesis. Thus, the evidence obtained from investigating "renal" atherogenesis could be of interest in improving our understanding of this disease process in the non-renal population. We review the relationship between "renal" and non-renal atherosclerosis focusing on pathogenesis, risk factors and clinical events and how they interact with treatment options. Overall, the "later" stages of CKD may eventually be considered as a coronary heart disease equivalent condition.

Vascular calcification: the role of microRNAs

“…Vascular calcification represents the deposition of calcium phosphate salts in the tunica media of the vascular wall (1,2). It occurs during aging but is accelerated and pronounced in patients with diabetes mellitus, chronic kidney disease (CKD) and established cardiovascular disease (1,2).…”

“…It occurs during aging but is accelerated and pronounced in patients with diabetes mellitus, chronic kidney disease (CKD) and established cardiovascular disease (1,2). Due to the loss of elasticity of the vessel wall, vascular calcification might result in left ventricular hypertrophy and compromise coronary perfusion (1,3).…”

High-density lipoprotein: quantity or quality?

“…Moreover, all-cause mortality is similar in patients with CKD and in those with a history of myocardial infarction (3). The pathogenesis of cardiovascular disease (CVD) in patients with CKD is multifactorial and includes increased oxidative stress, vascular calcification and subclinical inflammation (4).…”

“…Serum high-density lipoprotein cholesterol (HDL-C) levels are frequently reduced in patients with CKD (4,5). Moreover, HDL function appears to be impaired in CKD and the atheroprotective properties of HDL diminish as glomerular filtration rate (GFR) declines (4,5).…”

“…Moreover, HDL function appears to be impaired in CKD and the atheroprotective properties of HDL diminish as glomerular filtration rate (GFR) declines (4,5). The importance of HDL functionality versus HDL quantity has become apparent in recent years.…”