New markers of accelerated atherosclerosis in end-stage renal disease.
Over the last two decades, several studies have reported a high prevalence of cardiovascular disease in patients with end-stage renal disease (ESRD). This population usually presents both the traditional and non-traditional risk factors for atherosclerosis. Inflammation as well as impaired nitric oxide production are pivotal, throughout the whole process of development of atherosclerotic lesions from the very start. C-reactive protein (CRP), a marker of systemic inflammation and an independent predictor of cardiovascular mortality in the general population, and asymmetric dimethylarginine (ADMA), an endogenous inhibitor of NO synthase, are important risk factors for cardiovascular disease and mortality in the ESRD population. Increased CRP levels have been described in hemo-dialysis and peritoneal dialysis patients, probably due to concomitant diseases, recurrent infections and chronic dialytic therapy. CRP levels, however, are elevated even in predialysis patients, implying that factors related to uremia per se can promote CRP synthesis. Recent reports raise the question whether CRP could be more than just a sensitive marker of inflammation and may contribute actively to the development of the atherosclerotic lesion. ADMA accumulation in the ESRD population is a consequence of reduced renal excretion and impaired enzymatic degradation and is related to the progression of atherosclerosis. Both CRP and ADMA have been shown to be associated with increases in the incidence and progression of atherosclerotic lesions in carotid arteries, as evaluated by high-resolution Doppler ultrasonography.
Rattazzi
Marcello
M
Department of Clinical and Experimental Medicine, University of Padova, Padua, Italy.
Puato
Massimo
M
Faggin
Elisabetta
E
Bertipaglia
Barbara
B
Grego
Franco
F
Pauletto
Paolo
P
D001120:Arginine / Q000031:analogs & derivatives* / Q000032:analysis*; D015415:Biomarkers / Q000032:analysis*; D002097:C-Reactive Protein / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000453:epidemiology; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
D015415:Biomarkers; C018524:N,N-dimethylarginine; D002097:C-Reactive Protein; D001120:Arginine