Renal dysfunction and acceleration of coronary disease
Open Access
- 1 August 2004
- Vol. 90 (8), 961-966
- https://doi.org/10.1136/hrt.2003.015503
Abstract
Tens of millions of persons worldwide have combined cardiovascular disease (CVD) and CKD.1 In the USA alone, over 300 000 individuals are on renal replacement therapy (RRT),2 which confers a five- to 40-fold increased risk of fatal cardiovascular events.3w1 w2 CKD is commonly defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2, or the presence of a raised urinary albumin to creatinine ratio > 30 mg/g on a spot urine sample. Although conventional risk factors such as hypertension, diabetes mellitus, and dyslipidaemia are commonly associated with CKD and its attendant long term CVD morbidity, these risk factors alone do not fully explain the prevalence of CVD in this population.4 Figure 1 depicts the independent and dominant effect of renal disease on coronary heart disease death rates among diabetics. Novel risk factors such as homocysteinaemia (Hcy), raised lipoprotein Lp(a), oxidative stress, endothelial dysfunction, diminished transforming growth factor β1 (TGF-β1), chronic inflammation, and vascular calcification are increasingly linked to accelerated rates of atherogenesis in the setting of CKD. Furthermore, patients with CKD have inferior clinical outcomes following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) independent of procedural success.Keywords
This publication has 19 references indexed in Scilit:
- Acute Myocardial Infarction and Renal Dysfunction: A High-Risk CombinationAnnals of Internal Medicine, 2002
- Biphasic effects of hemodialysis on platelet reactivity in patients with end-stage renal disease: A potential contributor to cardiovascular riskAmerican Journal of Kidney Diseases, 2002
- Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patientsKidney International, 2002
- The impact of renal insufficiency on clinical outcomes in patients undergoing percutaneous coronary interventionsJournal of the American College of Cardiology, 2002
- Cardiorenal risk: an important clinical intersection.2002
- Low TGF-β1 serum levels are a risk factor for atherosclerosis disease in ESRD patientsKidney International, 2002
- Determinants of mortality after myocardial infarction in patients with advanced renal dysfunctionAmerican Journal of Kidney Diseases, 2001
- Coronary-Artery Calcification in Young Adults with End-Stage Renal Disease Who Are Undergoing DialysisNew England Journal of Medicine, 2000
- Hyperhomocyst(e)inemia and the prevalence of atherosclerotic vascular disease in patients with end-stage renal diseaseAmerican Journal of Kidney Diseases, 1999
- Epidemiology of cardiovascular disease in chronic renal disease.1998