Cases A, Vera M, López Gómez J M
Servicio de Nefrología, Unidad de Hipertensión Arterial, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona.
Nefrologia. 2002;22 Suppl 1:68-74.
Dialysis patients constitute a high-risk subset of patients for developing cardiovascular disease, which accounts for nearly 50% of deaths. After stratification for age, race and gender, cardiovascular mortality is 10-20 times higher in dialysis patients than in the general population. Cardiovascular disease in this population cannot be fully explained by the high prevalence of classical cardiovascular risk factors (age, hypertension, diabetes, hyperlipidemia, smoking, etc.). Thus, the involvement of "new" cardiovascular risk factors (hyperhomocysteinemia, hyperfibrinogenemia, high lipoprotein (a) levels, oxidative stress, inflammation, etc.), and uremia-related factors (anemia, impaired calcium-phosphorus metabolism, hyperparathyroidism, accumulation of endogenous inhibitors of nitric oxide synthesis, etc.) has been also invoked to play a role in the increased cardiovascular risk in these patients. Endothelial dysfunction is the initial event in the development of atherosclerosis. Uremic patients exhibit an endothelial dysfunction, even before starting dialysis, which persists o is even aggravated under dialysis treatment. Uremic patients must be considered at high risk of developing cardiovascular disease. Thus cardiovascular risk factors in these patients should be managed early, aggressive and multifactorially in order to reduce their high cardiovascular morbidity and mortality.
透析患者是发生心血管疾病的高危患者亚群，心血管疾病导致的死亡占近50%。在按年龄、种族和性别分层后，透析患者的心血管死亡率比普通人群高10至20倍。该人群中的心血管疾病不能完全用经典心血管危险因素（年龄、高血压、糖尿病、高脂血症、吸烟等）的高患病率来解释。因此，“新的”心血管危险因素（高同型半胱氨酸血症、高纤维蛋白原血症、高脂蛋白(a)水平、氧化应激、炎症等）以及与尿毒症相关的因素（贫血、钙磷代谢受损、甲状旁腺功能亢进、一氧化氮合成内源性抑制剂的蓄积等）也被认为在这些患者心血管风险增加中起作用。内皮功能障碍是动脉粥样硬化发展的起始事件。尿毒症患者甚至在开始透析前就表现出内皮功能障碍，在透析治疗期间持续存在甚至加重。必须将尿毒症患者视为发生心血管疾病的高危人群。因此，应尽早、积极且多因素地管理这些患者的心血管危险因素，以降低其高心血管发病率和死亡率。
