Shik John, Parfrey Patrick S
Health Sciences Centre, Memorial University of Newfoundland, St John's, Newfoundland, Canada.
Curr Opin Nephrol Hypertens. 2005 Nov;14(6):550-7. doi: 10.1097/01.mnh.0000170752.64150.88.
To review recent publications concerning the epidemiology and management of cardiovascular disease in the stages of chronic kidney disease.
Chronic kidney disease is a state of increased risk for atherosclerotic and cardiomyopathic disease. The mechanisms of cardiovascular disease probably change with the different stages of chronic kidney disease. Both proteinuria and decreased glomerular filtration rate are probably independent cardiovascular disease risk factors, although the impact of the latter is modest. Traditional risk factors are important predictors of cardiovascular disease in chronic kidney disease. Recent randomized controlled trials and cohort studies have supported interventions for smoking cessation, blood pressure control, renin-angiotensin system blockade, the correction of lipid abnormalities, and utilizing antiplatelet agents. Some uraemia-related risk factors predict the development of cardiovascular disease, particularly hypoalbuminaemia, inflammation, anaemia, and homocysteinaemia. However, randomized controlled trials of anaemia correction and of an increased quantity of dialysis were negative.
The role of oxidant stress, divalent ion abnormalities, various lipid abnormalities and other potential factors require further investigation. To determine whether these uraemia-related factors are markers of cardiovascular disease risk or are actually cardiotoxic requires additional randomized controlled trials.
综述近期有关慢性肾脏病各阶段心血管疾病流行病学及管理的出版物。
慢性肾脏病是动脉粥样硬化性疾病和心肌病风险增加的一种状态。心血管疾病的机制可能随慢性肾脏病的不同阶段而变化。蛋白尿和肾小球滤过率降低可能都是独立的心血管疾病危险因素，尽管后者的影响较小。传统危险因素是慢性肾脏病中心血管疾病的重要预测指标。近期的随机对照试验和队列研究支持针对戒烟、血压控制、肾素 - 血管紧张素系统阻断、纠正脂质异常以及使用抗血小板药物的干预措施。一些与尿毒症相关的危险因素可预测心血管疾病的发生，特别是低白蛋白血症、炎症、贫血和高同型半胱氨酸血症。然而，贫血纠正和增加透析量的随机对照试验结果为阴性。
氧化应激、二价离子异常、各种脂质异常及其他潜在因素的作用需要进一步研究。要确定这些与尿毒症相关的因素是心血管疾病风险的标志物还是实际具有心脏毒性，还需要更多的随机对照试验。
