[Cardiovascular events in chronic advanced renal insufficiency. Current concepts].
Patients with end-stage renal disease face a particularly high risk of cardiovascular disease and total mortality. Part of their increased risk is due to higher prevalence of established risk factors such as arterial hypertension, diabetes, smoking and anemia. Hypertension and diabetes have a very high prevalence in dialysis patients and play a major role in their high mortality and morbidity. Hyperparathyroidism, hyperhomocis-teinemia and disordered lipid metabolism represent factors which are peculiarly altered by the uremic state. Inflammatory processes, high sympathetic activity and the accumulation of an endogenous inhibitor of NO synthase (ADMA) have recently emerged as cardiovascular risk factors of paramount importance. Sleep apnea has been linked with nocturnal hypertension and could be implicated in the high prevalence of concentric hypertrophy of the left ventricle in these patients. Hypertension control as well as appropriate treatment of anaemia and cessation of smoking constitute fundamental areas of intervention in dialysis patients. It is possible that in the near future control of chronic inflammatory processes, of high sympathetic activity and endothelial dysfunction will further contribute to curb the exceedingly high cardiovascular mortality of patients on chronic dialysis treatment.
Zoccali
Carmine
C
Divisione Nefrologica e Centro di Fisiologia Clinica del C.N.R, Reggio Calabria.
D000740:Anemia / Q000150:complications; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology* / Q000401:mortality; D006801:Humans; D020138:Hyperhomocysteinemia / Q000150:complications; D006949:Hyperlipidemias / Q000150:complications; D006973:Hypertension / Q000150:complications; D007249:Inflammation / Q000150:complications; D007676:Kidney Failure, Chronic / Q000150:complications*; D019001:Nitric Oxide Synthase / Q000037:antagonists & inhibitors; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000150:complications; D012907:Smoking / Q000009:adverse effects
C018524:N,N-dimethylarginine; D002097:C-Reactive Protein; D001120:Arginine; D019001:Nitric Oxide Synthase