Chronic kidney disease as a metabolic syndrome with malnutrition--need for strict control of risk factors.
Patients with chronic kidney disease (CKD) have an increased risk for death from cardiovascular disease (CVD). They have multiple metabolic abnormalities that may accelerate atherosclerosis, such as hypertension, insulin resistance, and dyslipidemia, along with other CKD-related risk factors. In addition, a considerable proportion of patients with advanced stages of CKD are malnourished, presenting "metabolic syndrome with malnutrition". The presence of malnutrition/inflammation dramatically changes the apparent relationship between CVD death risk and some risk factors. For example, in stage 5 CKD patients on hemodialysis, a higher body mass index and a higher plasma cholesterol are predictors of better survival. To understand the paradoxic epidemiology, we should recognize risk factors for occurrence of CVD events and risk factors of fatality after an event. In this article, we review the unique situation of CKD, emphasizing the need of more strict control of both types of risk factors to improve survival of CKD patients.
Shoji
Tetsuo
T
Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka 545-8585.
Nishizawa
Yoshiki
Y
D002908:Chronic Disease; D014943:Global Health; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000401:mortality; D044342:Malnutrition / Q000150:complications*; D024821:Metabolic Syndrome / Q000150:complications*; D012307:Risk Factors; D015996:Survival Rate