The Cardiovascular Burden in End-Stage Renal Disease

Abstract

It is well documented that chronic kidney disease patients have an extremely high risk of developing cardiovascular (CV) disease (CVD) compared to the general population. Declining renal function itself represents a continuum of CV risk, and in those individuals who survive to reach end-stage renal disease, the risk of suffering a cardiac event is uncomfortably and unacceptably high. Several pathophysiological pathways have been suggested to account for this, including endothelial dysfunction, dyslipidemia, inflammation, left ventricular hypertrophy, troponins, phosphate, vitamin D, fibroblast growth factor-23, and NT-proBNP. All these conditions and biomarkers may have clear associations with current and subsequent CVD.

Cardiovascular disease in dialysis patients

“…In fact, an inhibition of leucocyte activity observed in HD patients may compromise infection response and trigger a condition of micro-inflammation and consequently atherosclerosis. Moreover, uraemic toxins induce an enhancement of leucocyte oxidative activity, an up-regulation in leucocyte–endothelial interactions and an infiltration of macrophages and monocytes into vascular atherosclerotic lesions [ 3 ].…”

“…The negative action of IS on the CV system seems to be concentration dependent. In CKD patients, IS induces a pro-oxidative action leading to increased CVD, while in normal renal function subjects, IS plays a potential protective role, eliminating hydroxyl radicals [ 3 ]. Several authors indicate a potential role of IS in the progression of vascular damage, haemostatic dysfunction and the progressive inflammatory process.…”

“…CVD is present in >50% of patients undergoing dialysis and the relative risk of death due to CVD events in HD patients is reported to be 20 times higher than in the general population. In fact, in patients on renal replacement therapy (RRT) the prevalence of coronary heart disease and ventricular hypertrophy has been described to be 40% and 70%, respectively [ 3 ]. The prevalence of hypertension, a major risk factor for coronary artery disease (CAD) and left ventricular hypertrophy (LVH) is high in patients with chronic kidney disease (CKD) (87–90%).…”

Diyal-TR Registry: Investigation of Clinical Characteristics of the Patients Under Chronic Hemodialysis Therapy in Turkey

“…15 Böbrek fonksiyonlarında azalma KV hastalık riskini artırırken, SDBH'ye ilerlemiş hastaların kardiyak olay yaşama riski oldukça yüksek hâle gelir. 16 Bizim çalışmamızda hastaneye yatış öyküsü olan hastaların %20'sinden fazlasında yatış nedeninin kardiyak olaylar olması da bunu desteklemektedir. KV hastalık riski yüksek olan bu SDBH popülasyonunda statin kullanım oranının <%10 olması ilk bakışta bu tabloya olumsuz etki ediyor gibi görünse de statinlerin diyaliz hastalarındaki KV olay geçirme riskine karşı koruyucu etkisi tartışmalıdır.…”

Quantification of Internal Filtration in Hollow Fiber Hemodialyzers with Medium Cut-Off Membrane

“…A significant correlation between uremia-retention molecules and specific clinical problems has been demonstrated, such as dialysis-related amyloidosis (β-2 microglobulin) [4] and malnutrition (inflammatory mediators, leptin and appetite-suppressing toxins) [8, 10, 11]. Cardiovascular complications and osteodystrophy are related to high levels of parathyroid hormone, homocysteine, and inflammatory cytokines [9]. Anemia has been correlated with specific erythropoiesis inhibitors and high levels of hepcidin [12-15].…”