Chavalitdhamrong Disaya, Danovitch Gabriel M, Bunnapradist Suphamai
Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
Semin Dial. 2007 Nov-Dec;20(6):544-8. doi: 10.1111/j.1525-139X.2007.00351.x.
Similar to the general population, cardiovascular disease is the leading cause of death in patients with a functioning renal graft. Recent studies have shown an inverse relationship between cardiovascular risk factors and outcomes in dialysis patients. Low blood pressure, low body mass index (BMI) and low serum cholesterol levels are correlated with a higher risk of adverse cardiovascular outcomes in dialysis patients. The explanation for these observations is unclear. In renal transplant recipients (RTR), these parameters are correlated with a lower risk of cardiovascular adverse outcomes, a phenomenon labeled as "reversal of reverse epidemiology." The aims of this review are: (1) to explore the association between cardiovascular risk factors and outcomes in RTR; (2) to assess whether these effects are reversal of the reverse epidemiology in dialysis predecessors; and (3) to determine the strategies for minimizing cardiovascular risk in RTR. This article also compares the determinants of cardiovascular risk factors among the general population, maintenance dialysis patients and RTR. Because definitive evidence on optimal intervention is lacking, population-specific clinical trials are needed to define optimum targets for treatment of these risk factors in maintenance dialysis patients and RTR separately.
与普通人群类似，心血管疾病是肾移植功能正常患者的主要死因。最近的研究表明，透析患者的心血管危险因素与预后之间存在负相关关系。低血压、低体重指数（BMI）和低血清胆固醇水平与透析患者发生不良心血管事件的较高风险相关。这些观察结果的解释尚不清楚。在肾移植受者（RTR）中，这些参数与较低的心血管不良事件风险相关，这一现象被称为“反向流行病学逆转”。本综述的目的是：（1）探讨RTR中心血管危险因素与预后之间的关联；（2）评估这些影响是否是透析前患者反向流行病学的逆转；（3）确定RTR中降低心血管风险的策略。本文还比较了普通人群、维持性透析患者和RTR中心血管危险因素的决定因素。由于缺乏关于最佳干预的明确证据，需要针对特定人群的临床试验来分别确定维持性透析患者和RTR中这些危险因素治疗的最佳目标。
