Zoccali C
Division of Nephrology, Hypertension and Renal Transplantation, CNR Centro di Fisiologia Clinica, Reggio Calabria, Italy.
Kidney Int. 2006 Jul;70(1):26-33. doi: 10.1038/sj.ki.5000417. Epub 2006 May 24.
Patients with chronic kidney disease (CKD) represent an important segment of the population (7-10%) and, mostly because of the high risk of cardiovascular complications associated with renal insufficiency, detection and treatment of CKD is now a public health priority. Traditional risk factors can incite renal dysfunction and cardiovascular damage as well. As renal function deteriorates, non-traditional risk factors play an increasing role both in glomerular filtration rate (GFR) loss and cardiovascular damage. Secondary analyses of controlled clinical trials suggest that inflammation may be a modifiable risk factor both for cardiac ischemia and renal disease progression in patients with or at risk of coronary heart disease. Homocysteine predicts renal function loss in the general population and cardiovascular events in end-stage renal disease (ESRD), but evidence that this sulfur amino acid is directly implicated in the progression of renal disease and in the high cardiovascular mortality of uremic patients is still lacking. High sympathetic activity and raised plasma concentration of asymmetric dimethylarginine (ADMA) have been associated to reduced GFR in patients with CKD and to cardiovascular complications in those with ESRD but again we still lack clinical trials targeting these risk factors. Presently, the clinical management of CKD patients remains largely unsatisfactory because only a minority of these attain the treatment goals recommended by current guidelines. Thus, in addition to research into new and established risk factors, it is important that nephrologists make the best use of knowledge already available to optimize the follow-up of these patients.
慢性肾脏病（CKD）患者占总人口的重要比例（7%-10%），而且主要由于与肾功能不全相关的心血管并发症风险很高，CKD的检测和治疗现已成为公共卫生的优先事项。传统危险因素也可引发肾功能障碍和心血管损害。随着肾功能恶化，非传统危险因素在肾小球滤过率（GFR）降低和心血管损害中发挥着越来越大的作用。对照临床试验的二次分析表明，炎症可能是冠心病患者或有冠心病风险的患者发生心肌缺血和肾病进展的一个可改变的危险因素。同型半胱氨酸可预测普通人群的肾功能丧失以及终末期肾病（ESRD）患者的心血管事件，但仍缺乏证据表明这种含硫氨基酸直接参与肾病进展以及尿毒症患者心血管高死亡率的发生。高交感神经活性和不对称二甲基精氨酸（ADMA）血浆浓度升高与CKD患者的GFR降低以及ESRD患者的心血管并发症相关，但同样，我们仍缺乏针对这些危险因素的临床试验。目前，CKD患者的临床管理仍大多不尽人意，因为这些患者中只有少数人达到了现行指南推荐的治疗目标。因此，除了研究新的和已确定的危险因素外，肾病学家充分利用现有知识以优化对这些患者的随访也很重要。
