Cardiovascular risk and management in chronic kidney disease

Abstract

Chronic kidney disease (CKD) is associated with accelerated progression of cardiovascular disease, perhaps because patients with CKD have a high burden of traditional cardiovascular risk factors in addition to a range of nontraditional risk factors such as inflammation and abnormal metabolism of calcium and phosphate. Although the cardiovascular burden of CKD is well documented, potentially beneficial therapies are sometimes underused in patients with stage 3-4 CKD and are rarely studied in patients on dialysis. In this Review, we describe the epidemiology of cardiovascular disease in patients with stage 3-5 CKD (excluding kidney transplant recipients) and outline cardiovascular risk factors that are relevant in this population; we then discuss the implications of this knowledge for the optimal management of cardiovascular risk in this setting. Finally, we highlight opportunities for further research.

Skin Autofluorescence and the Association with Renal and Cardiovascular Risk Factors in Chronic Kidney Disease Stage 3

“…The mechanisms for this association remain the focus of intense investigation. Whereas the role of traditional cardiovascular risk factors such as hypertension, diabetes, dyslipidemia, and smoking has been well described, a growing number of nontraditional risk factors, unique to CKD, are becoming appreciated (3,4). One of these novel risk factors is accumulation of advanced glycation end products (AGE), a heterogeneous group of compounds formed by the reaction of free amino groups on proteins, lipids, and nucleic acids with reactive carbonyl groups on reducing sugars (5).…”

Cardiovascular Burden Associated with Uremic Toxins in Patients with Chronic Kidney Disease

“…The association of CKD with CVD may be explained by the higher prevalence of nontraditional and traditional risk factors for CVD among patients with CKD compared with the general population [11,17]. Anemia, proteinuria, increases in levels of pro-inflammatory cytokines, oxidative stress, hyperhomocysteinemia, abnormal calcium and phosphate metabolism, and accumulation of uremic toxins constitute nontraditional risk factors, while traditional risk factors include hypertension, diabetes, advanced age, dyslipidemia, and tobacco use.…”

“…Additional risk factors seen in hemodialysis patients include bacteremia, extracellular fluid overload, and glycemic load. The relative contributions of individual risk factors are not well understood and may be dependent on CKD stage [17]. …”

Prevalência da doença periodontal em pacientes com doença renal crônica em hemodiálise

“…Os fatores de risco tradicionais: hipertensão, diabetes, tabagismo e dislipidemia (Muntner et al, 2004;Rucker;Tonelli, 2009;Gansevoort et al, 2013) parecem não ser suficientes para, sozinhos, justificar a alta taxa de mortalidade decorrente de problemas cardiovasculares nos doentes renais crônicos (Cheung et al, 2000). Pesquisas indicam que fatores de risco não tradicionais, como processos inflamatórios, estresse oxidativo, disfunção endotelial e distúrbios do metabolismo mineral e ósseo (Cheung et al, 2000;Himmelfarb et al, 2002;Muntner et al, 2004;Schiffrin et al, 2007;Rucker;Tonelli, 2009) também são importantes e exercem efeitos significativos sobre esses falecimentos Stenvinkel et al, 2000).…”

“…Pesquisas indicam que fatores de risco não tradicionais, como processos inflamatórios, estresse oxidativo, disfunção endotelial e distúrbios do metabolismo mineral e ósseo (Cheung et al, 2000;Himmelfarb et al, 2002;Muntner et al, 2004;Schiffrin et al, 2007;Rucker;Tonelli, 2009) também são importantes e exercem efeitos significativos sobre esses falecimentos Stenvinkel et al, 2000). Durante os últimos anos a inflamação tem ganhado importância dentro desse contexto devido a sua estreita relação com eventos ateroscleróticos tanto nos indivíduos com comprometimento renal quanto nos sistemicamente saudáveis (Zimmermann et al, 1999).…”