CARDIOVASCULAR DISEASE AND CHRONIC RENAL FAILURE

  • Robert Ekart Oddelek za nefrologijo Klinični oddelek za interno medicino Splošna bolnišnica Maribor Ljubljanska 5 2000 Maribor
  • Radovan Hojs Oddelek za nefrologijo Klinični oddelek za interno medicino Splošna bolnišnica Maribor Ljubljanska 5 2000 Maribor
  • Tanja Hojs-Fabjan Oddelek za nevrološke bolezni Splošna bolnišnica Ljubljanska 5 2000 Maribor
  • Breda Pečovnik-Balon Oddelek za nefrologijo Klinični oddelek za interno medicino Splošna bolnišnica Maribor Ljubljanska 5 2000 Maribor
  • Benjamin Dvoršak Oddelek za nefrologijo Klinični oddelek za interno medicino Splošna bolnišnica Maribor Ljubljanska 5 2000 Maribor
Keywords: atherosclerosis, arteriosclerosis, chronic renal failure, risk factors

Abstract

Background. Cardiovascular disease (CVD) is the main cause of morbidity and mortality in patients with chronic renal failure. CVD morbidity is approximately 10–20 times higher in patients with chronic renal failure compared with that in general population. The high prevalence of CVD among patients with chronic renal failure starting dialysis treatment suggests that CVD begins in earlier stages of chronic renal failure or disease.

Conclusions. This review discusses the major and other risk factors for CVD in patients with chronic renal failure. Prevention and treatment of CVD in patients with chronic renal failure should represent a great challenge for nephrologists in the future.

Downloads

Download data is not yet available.

References

Sarnak MJ, Levey AS. Cardiovascular disease and chronic renal disease: a new paradigm. Am J Kidney Dis 2000; 35: Suppl 1: S117–31.

London GM, Drüeke TB. Atherosclerosis and arteriosclerosis in chronic renal failure. Kidney Int 1997; 51: 1678–95.

Lindner A, Charra B, Sherrard DJ, Scribner BH. Accelerated atherosclerosis in prolonged maintenance hemodialysis. N Engl J Med 1974; 290: 697–701.

Locatelli F, Bommer J, London GM et al. Cardiovascular disease determinants in chronic renal failure: clinical approach and treatment. Nephrol Dial Transplant 2001; 16: 459–68.

Parfrey PS, Foley RN. The clinical epidemiology of cardiac disease in chronic renal failure. J Am Soc Nephrol 1999; 10: 1606–15.

Culleton BF, Wilson PWF. Cardiovascular disease: risk factors, secular trends and therapeutic guidelines. J Am Soc Nephrol 1998; 9: S5–15.

Foley RN, Parfrey PS, Sarnak MJ. Epidemiology of cardiovascular disease in chronic renal disease. J Am Soc Nephrol 1998; 9: S16–23.

Nichols WW, O’Rourke MF. Vascular impendance. In: Arnold E ed. McDonald’s blood flow in arteries: Theoretic, experimental and clinical principles. London: McDonald, 1991: 276–8.

O’Rourke MF. Mechanical principles in arterial disease. Hypertension 1995; 26: 2–9.

O’Rourke MF. Vascular impendance: The relationship between pressure and flow. In: Arterial function in health and disease. Edinburgh: Churchill Livingstone, 1982: 94–132, 185–243.

London GM, Guérin AP, Marchais SJ et al. Cardiac and arterial interactions in end-stage renal disease. Kidney Int 1996; 50: 600–8.

Kawagishi T, Nishizawa Y, Konishi T et al. High-resolution B-mode ultrasonography in evaluation of atherosclerosis in uremia. Kidney Int 1995; 48: 820–6.

Savage T, Clarke AL, Giles M, Tomson CRV, Raine AEG. Calcified plaque is common in the carotid and femoral arteries of dialysis patients without clinical vascular disease. Nephrol Dial Transplant 1998; 13: 2004–12.

Hojs R. Carotid intima-media thickness and plaques in hemodialysis patients. Artif Organs 2000; 9: 691–5.

Burdick L, Periti M, Salvaggio A et al. Relation between carotid artery atherosclerosis and time on dialysis. A non invasive study in vivo. Clin Nephrology 1994; 42: 121–6.

Pascazio L, Bianco F, Giorgini A, Galli G, Curri G, Panzetta G. Echo color doppler imaging of carotid vessels in hemodialysis patients: evidence of high levels of atherosclerotic lesions. Am J Kidney Dis 1996; 28: 713–20.

Hojs R, Hojs-Fabjan T, Pečovnik-Balon B. Atherosclerosis in patients with end-stage renal failure prior to initiation of hemodialysis. Nephrol Dial Transplant 2001; 16: A104–4.

Hojs R, Ekart R, Dvoršak B. Ateroskleroza pri bolnikih s kronično ledvično odpovedjo tik pred začetkom hemodializnega zdravljenja. In: ButurovičPonikvar J, Bren A eds. 2. slovenski nefrološki kongres z mednarodno udeležbo ob 30-letnici dialize in transplantacije ledvic v Sloveniji. Zbornik. Ljubljana: Klinični oddelek za nefrologijo, Interna klinika, Klinični center, 2000: 137–42.

Levin A, Singer J, Thompson CR, Ross H, Lewis M. Prevalent left ventricular hypertrophy in the predialysis population: Identifying opportunities for intervention. Am J Kidney Dis 1996; 27: 347–54.

Portoles J, Torralbo A, Martin P, Rodrigo J, Herrero JA, Barrientos A. Cardiovascular effects of recombinant human erythropoietin in predialysis patients. Am J Kidney Dis 1997; 29: 541–8.

Shulman NB, Ford CE, Hall WD et al. Prognostic value of serum creatinine and effect of treatment of hypertension on renal function. Hypertension 1989; 13: Suppl 1: I-80–93.

U. S. Renal Data System. USRDS 1998 annual data report. Bethesda: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 1998: 1–1.

Foley RN, Parfrey PS, Sarnak MJ. The clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998; 32: Suppl 3: S112–9.

Herzog CA, Ma JZ, Collins AJ. Poor long-term survival after myocardial infarction among patients on long-term dialysis. N Engl J Med 1998; 339: 799–805.

Donahue RP, Goldberg RJ, Chen Z, Gore JM, Alpert JS. The influence of sex and diabetes mellitus on survival following acute myocardial infarction: A community-wide perspective. J Clin Epidemiol 1993; 46: 245–52.

Harnett JD, Foley RN, Kent GM, Barre PE, Murray D, Parfrey PS. Congestive heart failure in dialysis patients: Prevalence, incidence, prognosis and risk factors. Kidney Int 1995; 47: 884–90.

Bennet WM, Kloster F, Rosch J, Barry J, Porter GA. Natural history of a asymptomatic coronary arteriographic lesions in diabetic patients with end-stage renal disease. Am J Med 1978; 65: 779–84.

Foley RN, Parfrey PS, Harnett JD et al. Clinical and echocardiographic disease in patients starting end-stage renal disease therapy. Kidney Int 1995; 47: 186–92.

U. S. Renal Data System. The USRDS dialysis morbidity and mortality study. Wave 2. Am J Kidney Dis 1997; 30: 2 Suppl 1: S67–85.

London GM, Fabiani F. Left ventricular dysfunction in end-stage renal disease: Echocardiographic insights. In: Parfrey PS, Harnett JD eds. Cardiac dysfunction in chronic uremia. Boston: Kluwer, 1992: 117–38.

Parfrey PS, Foley RN,Harnett JD, Kent GM, Murray D, Barre PE. Outcome and risk factors of ischemic heart disease in chronic uremia. Kidney Int 1996; 49: 1428–34.

Churchill DN, Taylor DW, Cook RJ et al. Canadian hemodialysis morbidity study. Am J Kidney Dis 1992; 19: 214–34.

Levey AS, Beto JA, Coronado BE et al. Controlling the epidemic of cardiovascular disease in chronic renal disease: What do we know? What do we need to learn? Where do we go from here? Am J Kidney Dis 1998; 32: 853–906.

Hojs R, Ekart R, Dvoršak B. Atherosclerosis in patients with analgesic nephropathy treated with hemodialysis. Nephrology 2002; 7: 272–6.

Raine AEG, Margreiter R, Brunner FP et al. Report on management of renal failure in Europe, XXII, 1991. Nephrol Dial Transplant 1992; 7: Suppl 2: 7–35.

Hojs R, Dvoršak B, Ekart R. Carotid intima-media thickness and plaques in patients with chronic renal failure at the start of hemodialysis. J Am Soc Nephrology, ASN program and abstracts 1998: American Society of Nephrology, 1998: 72A–2A.

Craven TE, Ryu JE, Espeland MA et al. Evaluation of the association between carotid artery atherosclerosis and coronary artery stenosis: a case control study. Circulation 1990; 82: 1230–42.

Salonen R, Seppanen K, Rauramaa R, Salonen JT. Prevalence of carotid atherosclerosis and serum cholesterol levels in eastern Finland. Arteriosclerosis 1988; 8: 788–92.

Pignoli P, Tremoli E, Poli A, Oreste P, Paoletti R. Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation 1986; 74: 1399–406.

Hojs R. Carotid intima-media thickness and plaques in hemodialysis patients. Ultrasound Med Biol 1997; 23: Suppl 1: S74–S74.

Parfrey PS, Harnett JD, Foley RN et al. Impact of renal transplantation on uremic cardiomyopathy. Transplantation 1995; 60: 908–14.

Lindholm A, Albrechtsen D, Frodin L, Tufveson G, Persson NH, Lundgren G. Ischemic heart disease: Major cause of death and graft loss after renal transplantation in Scandinavia. Transplantation 1995; 60: 451–7.

Parfrey PS, Griffiths SM, Harnett JD, Kent GM, Murray D, Barre PE. Outcome and risk factors of ischemic heart disease in chronic uremia. Kidney Int 1996; 49: 1428–34.

Coresh J, Longenecker JC, Miller III ER, Young HJ, Klag MJ. Epidemiolgy of cardiovascular risk factors in chronic renal disease. J Am Soc Nephrol 1998; 9: S24–30.

Foley RN, Parfrey PS, Harnett JD, Kent GM, Murray DC, Barre PE. Impact of hypertension on cardiomyopathy, morbidity and mortality in end-stage renal disease. Kidney Int 1996; 49: 1379–85.

London GM, Parfrey PS. Cardiac disease in chronic uremia: Pathogenesis. Adv Renal Replace Ther 1997; 4: 194–211.

Kannel WB, Gordon T, Schwartz MJ. Systolic versus diastolic blood pressure and risk of coronary heart disease: The Framingham study. Am J Cardiol 1971; 27: 335–46.

Wilking SV, Belanger A, Kannel WB, D’Agostino RB, Steel K. Determinants of isolated systolic hypertension. JAMA 1988; 260: 3451–5.

Vincenti F, Amend WJ, Abele J, Feduska NJ, Salvatierrajr O. The role of hypertension in hemodialysis-associated atherosclerosis. Am J Med 1980; 68: 363–9.

Levey AS, Eknoyan G. Cardiovascular disease in chronic renal disease. Nephrol Dial Transplant 1999; 14: 828–33.

Erturk S, Ertug AE, Ates K et al. Relationship of ambulatory blood pressure monitoring data to echocardiographic findings in hemodialysis patients. Nephrol Dial Transplant 1996; 11: 2050–4.

White WB. Ambulatory blood pressure monitoring: dippers compared with non-dippers. Blood Press Monit 2000; 5: Suppl 1: S17–23.

Covic A, Goldsmith DJ. Ambulatory blood pressure monitoring in nephrology: focus on BP variability. J Nephrol 1999; 12: 220–9.

Zavaroni I, Bonora E, Pagliara M et al. Risk factors for coronary artery disease in healthy persons with hyperinsulinemia and normal glucose tolerance. N Engl J Med 1989; 320: 702–6.

Lindholm B, Norbeck HE. Serum lipids and lipoproteins during continuous ambulatory peritoneal dialysis. Acta Med Scand 1986; 220: 143–51.

Després JP, Lamarche B, Mauriège P et al. Hyperinsulinemia as an independent risk factor for ischemic heart disease. N Engl J Med 1996; 334: 952–7.

Foley RN, Culleton BF, Parfrey PS et al. Cardiac disease in diabetic end-stage renal disease. Diabetologia 1997; 40: 1307–12.

Ando M, Lundkvist I, Bergström J, Lindholm B. Enhanced scavenger receptor expression in monocyte-macrophages in dialysis patients. Kidney Int 1996; 49: 773–80.

Witztum JL. The oxidation hypothesis of atherosclerosis. Lancet 1994; 344: 793–5.

Bucala R, Makita Z, Vega G et al. Modification of low density lipoprotein by advanced glycation end products contributes to the dyslipidemia of diabetes and renal insufficiency. Proc Natl Acad Sci USA 1994; 91: 9441–5.

Burdick L, Periti M, Salvaggio A et al. Relation between carotid artery atherosclerosis and time on dialysis. A non-invasive study. Clin Nephrol 1994; 42: 121–6.

Kronenberg F, Kathrein H, König P et al. Apolipoprotein (a) phenotypes predict the risk for carotid atherosclerosis in patients with end-stage renal disease. Arterioscler Thromb 1994; 14: 1405–11.

Kasiske BL. Hyperlipidemia in patients with chronic renal disease. Am J Kidney Dis 1998; 32: Suppl 3: S142–56.

Tschope W, Koch M, Thomas B et al. Serum lipids predict cardiac death in diabetic patients on maintenance haemodialysis: Results of prospective study. Nephron 1993; 64: 354–8.

Boerwinkle E, Leffert CC, Lin J, Lackner, Chiesa G, Hobbs HH. Apolipoprotein (a) gene accounts for greater than 90% of the variation in plasma lipoprotein (a) concentrations. J Clin Invest 1992; 90: 52–60.

Ekart R, Dvoršak B, Hojs R, Gorenjak M. Lipoprotein (a) pri bolnikih s končno odpovedjo ledvic, zdravljenih s kronično hemodializo. Zdrav Vestn 1999; 68: 429–32.

Albers JJ, Adolphson JL, Hazzard WR. Radio-immunoassay of human plasma Lp(a) lipoprotein. J Lipid Res 1977; 18: 331–8.

Angles-Cano E. Structural basis for the pathophysiology of lipoprotein (a) in the atherothrombotic process. Braz J Med Biol Res 1997; 30: 1271–80.

Dieplinger H, Lackner C, Kronenberg F et al. Elevated plasma concentrations of lipoprotein (a) in patients with end-stage renal disease are not relared to the size polymorphism of apolipoprotein (a). J Clin Invest 1993; 91: 397–401.

Cressman MD, Heyka RJ, Paganini EP, O’Neil J, Skibinski CI, Hoff HF. Lipoprotein (a) is an independent risk factor for cardiovascular disease in hemodialysis patients. Circulation 1992; 86: 475–82.

Cressman MD, Abood D, O’Neil J, Hoff HF. Lp(a) and premature mortality during chronic hemodialysis treatment. Chem Phys Lipids 1994; 67-68: 419–27.

Schaefer EJ, Lamon-Fava S, Jenner JL et al. Lipoprotein (a) levels and risk of coronary heart disease in men: The lipid research clinics coronary primary prevention trial. JAMA 1994; 271: 999–1003.

Haber E. Angiotensin-converting enzyme and lipoprotein (a) as risk factors for myocardial infarction. Circulation 1995; 91: 1888–90.

Kronenberg F. Lipoprotein (a) in renal disease: What we have, what we need, what we can forget. Nephrol Dial Transplant 1995; 10: 766–9.

Callow MJ, Verstuyft J, Tangirala R, Palinski W, Rubin EM. Atherogenesis in transgenic mice with human apolipoprotein B and lipoprotein (a). J Clin Invest 1995; 96: 1639–46.

Massy ZA, Bader CA, Chevalier A et al. Serum lipoprotein (a) levels in chronic renal failure and renal transplant patient. J Nephrol 1994; 7: 229–36.

Dvoršak B, Hojs R. Hiperhomocisteinemija pri hemodializnih bolnikih. In: Buturović-Ponikvar J, Bren AF eds. Zbornik 2. slovenski nefrološki kongres z mednarodno udeležbo ob 30-letnici dialize in transplantacije ledvic v Sloveniji; 27.–30. 9. 2000, Brdo pri Kranju. Ljubljana: Klinični center, Klinični oddelek za nefrologijo, 2000: 237–42.

Nygard O, Nordrehaug JE, Refsum H, Ueland PM, Farstad M, Vollset SE. Plasma homocysteine levels and mortality in patients with coronary artery disease. N Engl J Med 1997; 337: 230–6.

Descombes E, Hanck AB, Fellay G. Water-soluble vitamins in chronic hemodialysis patients and need for supplementation. Kidney Int 1993; 43: 1319–28.

Hultberg B, Andersson A, Arnadottir M. Reduced, free and total fractions of homocysteine and other thiol compounds in plasma from patients with renal failure. Nephron 1995; 70: 62–7.

Bostom AG, Shemin D, Lapane KL et al. High dose-vitamin B treatment of hyperhomocysteinemia in dialysis patients. Kidney Int 1996; 49: 147–52.

Amann K, Gross ML, London GM et al. Hyperphosphataemia – a silent killer of patients with renal failure? Nephrol Dial Transplant 1999; 14: 2085–7.

Drüeke T, Fleury J, Touré Y et al. Effect of parathyroidectomy on left ventricular function in hemodialysis patients. Lancet 1980; 1: 112–4.

Zucchelli P, Santoro A, Zucchelli M et al. Long-term effects of parathyroidectomy on cardiac and autonomic nervous system functions in hemodialysis patients. Nephrol Dial Transplant 1988; 3: 45–50.

Fellner SK, Lang RM, Neumann A et al. Parathyroid hormone and myocardial performance in dialysis patients. Am J Kidney Dis 1991; 18: 320–5.

London GM, Pannier B, Marchais SJ, Guérin AP. Calcification of the aortic valve in the dialysed patients. J Am Soc Nephrol 2000; 11: 778–83.

Goodman WG, Goldin J, Kuizon BD et al. Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 2000; 342: 1478–83.

Urena P, Malergue MC, Goldfarb B, Prieur P, Guédon-Rapoud C, Pétrover M. Evolutive aortic stenosis in haemodialysis patients: analysis of risk factors. Nephrologie 1999; 20: 217–25.

Guérin AP, London GM, Marchais SJ, Metivier F. Arterial stiffening and vascular calcifications in end-stage renal disease. Nephrol Dial Transplant 2000; 15: 1014–21.

Milliner DS, Zinsmeister AR, Lieberman E, Landing B. Soft tissue calcification in pediatric patients with end-stage renal disease. Kidney Int 1990; 38: 931–6.

Block GA, Hulbert-Shearon TE, Levin NW, Port FK. Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic haemodialysis patients: a national study. Am J Kidney Dis 1998; 31: 607–17.

Foley RN, Parfrey PS, Harnett JD, Kent GM, Murray DC, Barre PE. The impact of anemia on cardiomyopathy, morbidity and mortality in endstage renal disease. Am J Kidney Dis 1996; 28: 53–61.

Harnett JD, Kent GM, Foley RN, Parfrey PS. Cardiac function and hematocrit level. Am J Kidney Dis 1995; 25: Suppl 4: S3–7.

Brunkhorst R, Nonnast-Daniel B, Koch KM, Frei U. Hypertension as a possible complication of recombinant human erythropoetin therapy. Contrib Nephrol 1991; 88: 118–25.

Eckardt KU. Cardiovascular consequences of renal anaemia and erythropoetin therapy. Nephrol Dial Transplant 1999; 14: 1317–23.

Kannel WB, D’Agostino RB. Risk reduction after quitting smoking. Quality of Life and Cardiovascular Care 1989; 1: 84–5.

Ross R. Atherosclerosis – an inflammatory disease. N Engl J Med 1999; 340: 115–26.

Ridker PM, Cushman M, Stampher MJ, Tracy RP, Hennekens CH. Inflammation, aspirin and the risk of cardiovascular disease in apparently healthy men. N Engl J Med 1997; 336: 973–9.

Stenvinkel P, Heimburger O, Tuck CH, Berglund L. Apo(a)-isoform size, nutritional status and inflammatory markers in chronic renal failure. Kidney Int 1998; 53: 1336–42.

Zimmermann J, Herrlinger S, Pruy A, Metzger T, Wanner C. Inflammation enhances cardiovascular risk and mortality in hemodialysis patients. Kidney Int 1999; 55: 648–58.

Yeun JY, Levine RA, Mantadilok V, Kaysen GA. C-reactive protein predicts all-cause and cardiovascular mortality in hemodialysis patients. Am J Kidney Dis 2000; 35: 469–76.

Steinvinkel P, Heimburger O, Jogestrand T, Karnell A, Samuelsson A. Does persistent infection with Chlamydia pneumonia increase the risk of atherosclerosis in chronic renal failure. Kidney Int 1999; 55: 2531–2.

Danesh J, Whincup P, Walker M et al. Chlamydia pneumoniae IgG titres and coronary heart disease: prospective study and meta-analysis. BMJ 2000; 321: 208–13.

Zhou YF, Leon MB, Waclawiw MA et al. Association between prior cytomegalovirus infection and the risk of restenosis after coronary atherectomy. N Engl J Med 1996; 335: 624–30.

How to Cite
1.
Ekart R, Hojs R, Hojs-Fabjan T, Pečovnik-Balon B, Dvoršak B. CARDIOVASCULAR DISEASE AND CHRONIC RENAL FAILURE. TEST ZdravVestn [Internet]. 1 [cited 5Aug.2024];72(3). Available from: http://vestnik-dev.szd.si/index.php/ZdravVest/article/view/1814
Section
Review