title: Roles of metabolic and endocrinological alterations in atherosclerosis and cardiovascular disease in renal failure: another form of metabolic syndrome.
abstract: Patients with end-stage renal disease have markedly increased risk for death from cardiovascular disease. Renal failure is associated with multiple metabolic and endocrinologic abnormalities, and these alterations are involved in advanced atherosclerosis and high cardiovascular risk. Increased insulin resistance index by homeostasis model assessment (HOMA-IR), a simple index of insulin resistance, was an independent predictor of cardiovascular mortality in nondiabetic patients on maintenance hemodialysis. Renal failure impairs lipoprotein metabolism leading to the atherogenic lipoprotein profile characterized by increased triglyceride-rich remnant lipoproteins such as intermediate-density lipoprotein, an independent factor of increased aortic stiffness. Non-high-density lipoprotein cholesterol, the sum of cholesterol of intermediate-density lipoprotein and other apoB-containing lipoproteins, is an independent factor associated with increased arterial thickness and a predictor of cardiovascular death in hemodialysis patients. The risk for cardiovascular death in hemodialysis patients is associated closely with hypertension and malnutrition, but not with obesity. The constellation of insulin resistance, dyslipidemia, hypertension, and malnutrition in renal failure suggests the presence of another type of metabolic syndrome promoting cardiovascular disease. In addition, vitamin D deficiency and abnormalities in calcium, phosphate, and parathyroid hormone levels increase the death risk from cardiovascular disease in renal failure. It is expected that treatment of these metabolic and endocrinologic alterations would improve the survival of patients with renal failure.
authors.affiliation: Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Medical School, Osaka, Japan. yynisizawa@med.osaka-cu.ac.jp
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Nishizawa
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Shoji
authors.forename: Masanori
authors.initials: M
authors.lastname: Emoto
authors.forename: Hideki
authors.initials: H
authors.lastname: Koyama
authors.forename: Hideki
authors.initials: H
authors.lastname: Tahara
authors.forename: Shinya
authors.initials: S
authors.lastname: Fukumoto
authors.forename: Masaaki
authors.initials: M
authors.lastname: Inaba
authors.forename: Eiji
authors.initials: E
authors.lastname: Ishimura
authors.forename: Takami
authors.initials: T
authors.lastname: Miki
mesh_terms: D001161:Arteriosclerosis / Q000209:etiology / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000378:metabolism*; D004700:Endocrine System Diseases / Q000209:etiology*; D006801:Humans; D024821:Metabolic Syndrome / Q000209:etiology*; D051437:Renal Insufficiency / Q000150:complications*