Epidemiology and Mechanisms of Uremia-Related Cardiovascular Disease

Abstract

Abstract-Patients with chronic kidney disease and end-stage renal disease are at 5-to 10-fold higher risk for developing cardiovascular disease (CVD) than age-matched controls. Clinically, CVD in this population manifests as coronary artery disease, arrhythmias, stroke, or congestive heart failure. Beyond the traditional risk factors (eg, diabetes mellitus and hypertension), uremia-specific factors that arise from accumulating toxins also contribute to the pathogenesis of CVD.In this review, we summarize the literature on the epidemiology of both traditional and uremia-related CVD and focus on postulated mechanisms of the latter. P. Jousset, MD, 1 describing common causes of death among patients with Bright disease C hronic kidney disease (CKD) is an increasingly urgent public health concern that is projected to grow worldwide at a rate of 8% annually, with the fastest growth expected in developing nations.2,3 It has long been known that patients with kidney failure are predisposed to cardiovascular disease (CVD) that manifests clinically in various forms, including coronary artery disease, atrial or ventricular arrhythmias, myocardial infarction, stroke, or congestive heart failure. Over the last 30 years, it has become clear that the risk of CVD increases early in the course of progressive kidney disease and that the epidemiology, pathophysiology, prevention, and treatment of CVD and CKD are closely related and interdependent. 4 In this review, we initially describe the epidemiology of CVD among people with CKD, noting the limitations of available research. We then discuss common risk factors for CVD (traditional and nontraditional) and key shared aspects of its pathophysiology with CKD. Next we describe emerging diagnostic tools and novel therapies that may help to delay or prevent end-stage renal disease (ESRD) and to curtail the escalating burden of cardiorenal disease. In the final section, we discuss the health services and health policy challenges that CKD and its inextricably linked CVD morbidities pose worldwide, particularly for low-and middle-income countries (LMICs). Phenotypes and Epidemiology of CVD in Patients With CKDPatients with CKD and some forms of CVD share a number of risk factors and underlying pathophysiological mechanisms that, by virtue of their similarities, offer opportunities to improve their management. The epidemiology of 4 of the commonest clinical phenotypes of CVD associated with CKD is discussed below. Coronary Artery DiseaseCoronary artery disease (CAD) is a leading cause of death among people with advanced CKD. Clinical syndromes compatible with CAD (including angina and myocardial infarction) are exceedingly common in patients with nondialysis-dependent CKD, and the incidence of myocardial

Inverse Association Between Serum Non–High‐Density Lipoprotein Cholesterol Levels and Mortality in Patients Undergoing Incident Hemodialysis

“…37 It is well known that nontraditional risk factors, such as oxidative stress, inflammation, and the resultant cachexia and protein energy wasting, play a major role in the mortality associated with ESRD and hemodialysis. 38,39 Therefore, although factors that improve energy delivery and metabolism in populations not at risk for protein energy wasting may be associated with obesity and worse outcomes, in the population undergoing hemodialysis, these features may play a more complex role, leading to their association with improved survival. Nevertheless, it is also critical to note that these associations are not necessarily indicative of a causal relationship and may be surrogates for unidentified mechanisms that can link energy metabolism, lipoproteins, and outcomes in ESRD.…”

Identificação de risco cardiovascular pela razão triglicerídeo/HDL-colesterol em pacientes com doença renal crônica em hemodiálise

“…Sabe-se que a população com DRC apresenta uma elevada prevalência de fatores de risco cardiovascular, como dislipidemia, obesidade, hipertensão e tabagismo. Alguns estudos evidenciam também a uremia na patogênese da doença cardiovascular, bem como albuminúria e/ou redução da taxa de filtração glomerular [21][22][23][24][25][26][27].…”

High Neutrophil-to-Lymphocyte Ratio is a Significant Predictor of Cardiovascular and All-Cause Mortality in Patients Undergoing Peritoneal Dialysis

“…The high cardiovascular mortality associated with chronic renal disease, especially in patients with end-stage renal disease (ESRD), is not entirely explained by traditional cardiovascular risk factors [2]. Microinflammation is a key factor in the malnutritioninflammation-atherosclerosis/calcification syndrome, which further accelerates the progression of atherosclerosis and is associated with increased risk of cardiovascular disease in patients on PD [3].…”