Prevalence of vascular risk factors and vascular disease in predialysis chronic renal failure

Abstract

Patients with end-stage renal disease have a high mortality, with the majority of deaths due to vascular disease. The prevalence of vascular risk factors and vascular disease in predialysis chronic renal failure (CRF) is poorly characterized. The aim of the present study was to determine the prevalence of vascular risk factors and clinically overt vascular disease in an Australian cohort of patients with predialysis CRF. We performed a retrospective chart review of outpatients with CRF and noted demographic data, the cause of renal failure, the presence or otherwise of vascular risk factors and vascular disease and calculated glomerular filtration rate. The prevalence of overt vascular disease and modifiable vascular risk factors was calculated. One hundred and eighty patients completed the study. Eighty-nine per cent of patients had hypertension, 68% had dyslipidaemia, 32% were diabetic and 38% were previous smokers. The subgroup with diabetic nephropathy had significantly more risk factors (P < 0.001) than other groups. Twenty-seven per cent of the group had cardiovascular disease, 22% had cerebrovascular disease, 23% had peripheral vascular disease and 9% had renal artery stenosis. Patients with ischaemic nephropathy had significantly more vascular disease than other groups (P < 0.001). Patients with overt vascular disease were older, had a higher number of risk factors and a higher calcium phosphate product than those without vascular disease. In conclusion, the present study suggests a high prevalence of vascular risk factors and vascular disease in predialysis CRF. Early detection provides an opportunity for early intervention and may help reduce the development of vascular disease, and the associated mortality, once these patients progress to dialysis.

The Diabetic Foot in End Stage Renal Disease

“…[39,59,60] Certainly, diabetic nephropathy, especially ESRD, is accompanied by an increased prevalence of peripheral arterial disease, [5,6,60] largely associated with longer diabetes duration [5,6,59] but also with a significantly more frequent presence of vascular risk factors. [5,61] Similarly, neuropathy is particularly common, possibly aggravated by a component of uremic neuropathy. [59] Specifically, the co-existence of neuropathy and peripheral arterial disease has been found to be significantly (p = 0.015) more common in patients on dialysis than in the general diabetic population.…”

Should we quantify insulin resistance in patients with renal disease? (Review Article)

“…5,6 These include a high prevalence of traditional cardiovascular risk factors. 7,8 Insulin resistance (IR) has been reported in patients with renal disease, 9 irre-spective of diagnosis, although the timing of its development remains somewhat controversial given the proportion of the normal population with features of the metabolic syndrome. It has also been recognized that the presence of hyperinsulinaemia may exert deleterious effects on vasculature even in the absence of hyperglycaemia.…”

“…CKD is associated with a number of metabolic, nutritional and vascular abnormalities which may contribute to increased vascular risk 5,6 . These include a high prevalence of traditional cardiovascular risk factors 7,8 . Insulin resistance (IR) has been reported in patients with renal disease, 9 irrespective of diagnosis, although the timing of its development remains somewhat controversial given the proportion of the normal population with features of the metabolic syndrome.…”

Atherosclerosis and Folic Acid Supplementation Trial: Untangling the web of cardiac risk in chronic kidney disease

“…Accelerated cardiovascular disease has been documented at the initiation of dialysis, 4 suggesting that the excess risk occurs at an earlier stage of chronic kidney disease (CKD), prior to the initiation of dialysis. Recent data confirms a high prevalence of vascular disease in mild to moderate CKD 5,6 . A complex web of ‘traditional’ vascular risk factors, metabolic abnormalities and chronic inflammation has been implicated in the pathogenesis of the accelerated vascular disease of CKD.…”

“…A complex web of ‘traditional’ vascular risk factors, metabolic abnormalities and chronic inflammation has been implicated in the pathogenesis of the accelerated vascular disease of CKD. The majority of patients with ESRD or CKD have at least one ‘traditional’ vascular risk factor, such as hypertension and dyslipidaemia, and it is common for these patients to have multiple vascular risk factors 5,6 . Additionally, metabolic abnormalities associated with CKD, such as insulin resistance, 7 changes to calcium–phosphate homeostasis, 8 accumulation of endogenous nitric oxide synthase‐inhibitors, 9 and hyperhomocysteinaemia, 10 may conceivably accelerate vascular disease.…”