Levin Adeera, Stevens Lesley, McCullough Peter A
Division of Nephrology, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada.
Postgrad Med. 2002 Apr;111(4):53-60. doi: 10.3810/pgm.2002.04.1168.
The interlinking of CVD with CKD is undeniable. CVD accounts for more than 50% of all morbidity and mortality in patients with kidney disease who have undergone renal replacement therapy, and CVD is also prevalent in patients with mild and moderately severe kidney disease. To help address the elevated risks of these patients, primary care physicians need to maintain vigilance in (1) identifying patients who have CKD and (2) implementing strategies for reducing the prevalence of CVD in this population. It is essential that patients be screened for relatively mild kidney disease by measurement of serum creatinine and urine microalbumin and by calculation of the glomerular filtration rate in mL/min/1.73 m2 using equations based on serum creatinine. Rigorous assessment of conventional risk factors, including dyslipidemia, hypertension, and diabetes, is also necessary to prevent the poor outcomes currently observed in persons with CKD. Routine use of ACE inhibitors and aspirin is encouraged in all patients with CKD, and strict glycemic and blood pressure control is recommended for optimal outcomes. In addition, patients should be screened and treated for risk factors particularly associated with kidney disease and CVD morbidity and mortality, including anemia, hyperphosphatemia, and hyperparathyroidism. Finally, physicians should be careful to avoid therapeutic nihilism in patients with kidney disease; those at highest risk of CVD are likely to receive the greatest benefit from cardiovascular therapies.
心血管疾病（CVD）与慢性肾脏病（CKD）之间的内在联系是不可否认的。在接受肾脏替代治疗的肾病患者中，CVD占所有发病和死亡病例的50%以上，而且在轻度和中度严重肾病患者中CVD也很普遍。为了帮助应对这些患者风险的增加，初级保健医生需要保持警惕，做到：（1）识别患有CKD的患者；（2）实施降低该人群CVD患病率的策略。至关重要的是，要通过检测血清肌酐和尿微量白蛋白，并使用基于血清肌酐的公式计算肾小球滤过率（单位为mL/min/1.73 m²），来筛查相对轻度的肾病患者。为防止目前在CKD患者中观察到的不良后果，对包括血脂异常、高血压和糖尿病在内的传统危险因素进行严格评估也是必要的。鼓励所有CKD患者常规使用血管紧张素转换酶抑制剂（ACE抑制剂）和阿司匹林，建议严格控制血糖和血压以获得最佳疗效。此外，应对与肾病以及CVD发病和死亡特别相关的危险因素进行筛查和治疗，这些因素包括贫血、高磷血症和甲状旁腺功能亢进。最后，医生应注意避免对肾病患者采取治疗虚无主义态度；CVD风险最高的患者可能从心血管治疗中获益最大。
