[Proatherogenic changes induced by hemodialysis; probably a result of bio-incompatibility].
Chronic haemodialysis patients have a disproportionately high risk for developing cardiovascular disease, which can only in part be explained by known risk factors such as dyslipidaemia, hypertension, hyperhomocysteinemia, diabetes mellitus and chronic volume expansion. A possible cause is that the haemodialysis treatment itself contributes to the accelerated atherosclerosis, observed in these patients. Nowadays, atherosclerosis is considered an inflammatory process, mediated by a dysfunction of the vascular endothelium. As a result, blood cells adhere to the vascular surface and release a variety of vasoactive mediators, cytokines, growth factors and free radicals. Due to the contact between blood and dialyzer, humoral systems and cellular elements are stimulated, and this may be viewed as an inflammatory reaction. As a consequence of this, the vascular surface of haemodialysis patients is repeatedly exposed to the influences of cytokines, coagulation products, vasoactive mediators, stimulated leukocytes and thrombocytes, and oxidative stress. It is therefore conceivable that the haemodialysis treatment itself enhances the greatly increased cardiovascular risk in chronic haemodialysis patients.
Nubé
M J
MJ
Medisch Centrum Alkmaar, afd. Nefrologie en Dialyse, Wilhelminalaan 12, 1815 JD Alkmaar. nube.grooteman@wxs.nl
Vervloet
M G
MG
D000210:Acute-Phase Reaction / Q000139:chemically induced / Q000276:immunology*; D000925:Anticoagulants / Q000627:therapeutic use; D001161:Arteriosclerosis / Q000209:etiology* / Q000276:immunology / Q000517:prevention & control; D002908:Chronic Disease; D020099:Coated Materials, Biocompatible; D015314:Dialysis Solutions / Q000009:adverse effects*; D006801:Humans; D007688:Kidneys, Artificial; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors
D000925:Anticoagulants; D020099:Coated Materials, Biocompatible; D015314:Dialysis Solutions