Yerram Preethi, Karuparthi Poorna R, Hesemann Laura, Horst Jennifer, Whaley-Connell Adam
Department of Internal Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA.
J Am Soc Hypertens. 2007 May-Jun;1(3):178-84. doi: 10.1016/j.jash.2007.01.010.
Chronic kidney disease (CKD) is a global public health concern, and there is emerging a strong relationship between CKD and increased cardiovascular disease (CVD) risk. CKD in the presence of other co-morbidities such as type 2 diabetes mellitus (T2DM) and hypertension (HTN) can lead to early progression to end-stage renal disease (ESRD/stage V CKD) and confer a greater risk for CVD morbidity and mortality. CVD events are the leading cause of premature death in patients with CKD, even before their progression to ESRD, with the rate of CVD progression being twice as common compared with the general population. The higher mortality from CVD persists even after adjusting for most of the traditional risk factors, suggesting the possible contributions of uremia-related, nontraditional risk factors. This has led to the current understanding that the pathophysiology of CVD in CKD involves a complex interplay of both the traditional as well as nontraditional, uremia-related risk factors. This review will elaborate on the pathophysiology of CVD in CKD and will discuss the role of microalbuminuria (MAU)-proteinuria as a potential diagnostic and prognostic tool for CVD in CKD risk assessment.
慢性肾脏病（CKD）是一个全球性的公共卫生问题，并且CKD与心血管疾病（CVD）风险增加之间正显现出密切关系。存在2型糖尿病（T2DM）和高血压（HTN）等其他合并症的CKD可导致早期进展至终末期肾病（ESRD/CKD 5期），并使CVD发病和死亡风险更高。CVD事件是CKD患者过早死亡的主要原因，甚至在其进展至ESRD之前就是如此，CVD进展发生率是普通人群的两倍。即使在对大多数传统危险因素进行校正之后，CVD导致的较高死亡率仍然存在，这提示了与尿毒症相关的非传统危险因素可能发挥的作用。这使得目前人们认识到，CKD中CVD的病理生理学涉及传统以及与尿毒症相关的非传统危险因素之间的复杂相互作用。本综述将详细阐述CKD中CVD的病理生理学，并将讨论微量白蛋白尿（MAU）-蛋白尿作为CKD风险评估中CVD潜在诊断和预后工具的作用。
