Chronic renal dysfunction as an independent risk factor for the development of cardiovascular disease.
Cardiac disease is the leading cause of death in patients having end-stage renal disease (ESRD). Patients with ESRD have a higher risk for developing coronary artery disease (CAD) than one would estimate from the presence of traditional risk factors such as hypertension, diabetes, hyperlipidemia, and cigarette smoking. Patients with milder forms of renal dysfunction who do not require dialysis also appear to have an increased risk for CAD. ESRD is associated with anemia, hyperhomocystinemia, increased calcium-phosphate product, hypoalbuminemia, increased troponin, increased markers of inflammation, increased oxidant stress, and decreased nitric oxide activity, factors that could contribute to increased CAD risk. Patients with ESRD require aggressive management of traditional risk factors for CAD, which include hypertension, hyperlipidemia, hyperhomocystinemia, and hypercoagulability. Milder forms of renal dysfunction could also be predictors of occult CAD and should be screened for in assessing cardiac risk in asymptomatic individuals.
Varma
Raja
R
Department of Medicine, Divisions of Nephrology and Cardiology, New York Medical College/Westchester Medical Center, Valhalla, New York 10595, USA.
Garrick
Renee
R
McClung
John
J
Frishman
William H
WH
D015415:Biomarkers; D003324:Coronary Artery Disease / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D006435:Renal Dialysis; D012307:Risk Factors
D015415:Biomarkers