Artériás érfalmerevség és kardiovaszkuláris szövődmények krónikus vesebetegségben

Abstract

It is well established that cardiovascular complications are more frequent in patients with chronic kidney disease (CKD) than in the general population, as a result of accelerated atherosclerosis. CKD is an independent risk factor of cardiovascular disease (CVD). Premature death in CKD occurs mainly as a consequence of cardiovascular disease that develops during the disease course, and not owing to renal failure causes. It is estimated that risk of cardiovascular events may increase from 40% to 100% even in early CKD stages. The development of vascular injury and increased vascular stiffness due to, in part, vascular calcification is observed in CKD with decreasing renal function, and myocardial function also worsen leading to increased arrhythmia risk, as well as left ventricular systolic and diastolic dysfunction. In addition, mineral bone metabolic disturbances (CKD-MBD) may also develop in CKD parallel with the deterioration of renal function contributing to the increased vascular stiffness via extraosseal calcification in the vessels. In CKD patients the risk of cardiac death is 10-20 times higher compared to non-renal patients. Although underlying mechanisms in the development and progression of CVD are not precisely characterized in CKD, both traditional risk factors (hypertension, diabetes, dyslipidemia, obesity, age) and non-traditional risk factors play important roles in the CKD-related cardiovascular complications, such as endothelial dysfunction, increased sympathetic activity, oxidative stress, hyperhomocysteinemia, anemia, advanced glycated end product upsurge, CKD-MBD, secondary hyperparathyroidism, and subclinical inflammation.