Chronic Inflammation and Coronary Atherosclerosis in Patients with End-Stage Renal Disease

Abstract

The key role of chronic inflammation in the pathogenesis of atherosclerosis has become increasingly apparent in recent years based on the results of experimental, epidemiologic and clinical studies. Coronary artery disease and its complications occur with disproportionately high frequency in patients with end-stage renal disease (ESRD) and contribute substantially to cardiovascular morbidity and mortality in this population. Traditional cardiovascular risk factors occur commonly in patients with ESRD. In addition, a variety of patient-related and dialysis-related factors unique to ESRD predispose to chronic inflammation and by doing so are thought to contribute to coronary atherosclerosis and its complications. These risk factors may serve as therapeutic targets and as such may offer the potential for altering the natural history of coronary atherosclerosis in ESRD.

Cardiac sympathetic hyperactivity in chronic kidney disease — a comparison between haemodialysis and peritoneal dialysis patients

“…Hypertension and atherosclerosis are major risk factors of extensive morbidity and mortality in those patients. Beyond traditional atherosclerosis accelerating factors like: diabetes, hypertension, obesity, dyslipidaemia, smoking, uraemia induced endothelial dysfunction and production of pro-inflammatory cytokines [46], there is also an increased activation of the sympathetic nervous system. Cardiovascular complications lead to death in 45-50% of all pa-tients receiving dialysis, while 25% of the deaths in this group of patients were associated with CAD [46].…”

“…Beyond traditional atherosclerosis accelerating factors like: diabetes, hypertension, obesity, dyslipidaemia, smoking, uraemia induced endothelial dysfunction and production of pro-inflammatory cytokines [46], there is also an increased activation of the sympathetic nervous system. Cardiovascular complications lead to death in 45-50% of all pa-tients receiving dialysis, while 25% of the deaths in this group of patients were associated with CAD [46]. In respect to this situation, myocardial perfusion SPECT stress/rest study could be an excellent tool in predicting both cardiac events and the risk of SCD stratification in ESRD patients [47,48].…”

Low parathyroid hormone status induced by high dialysate calcium is an independent risk factor for cardiovascular death in hemodialysis patients

“…1 In addition to traditional CV risk factors, other disorders promote atherosclerosis and arteriosclerosis. [2][3][4] Abnormalities of mineral and bone metabolism-called "CKD-MBD" for "chronic kidney disease-mineral and bone disorder"-have been shown to contribute to alterations of arterial structure and function. Among them, hyperphosphatemia, hypercalcemia, and secondary hyperparathyroidism have been associated with CV calcifications, CV events, and death.…”

Revascularization versus Medical Management of Coronary Artery Disease in Prerenal Transplant Patients: A Meta-Analysis

“…CKD and ESRD lead to activation of renin-angiotensin-aldosterone system, oxidative stress, and inflammation, with increased cytokines and dyslipidemia leading to acceleration of atherosclerosis [10][11][12]. Additionally, myocardial structural changes, endothelial dysfunction, and vascular calcification, combined with dialytic and electrolyte changes, result in a 14-fold increase in sudden cardiac death [11,13,14].…”