Department of Renal Medicine, Hull and East Yorkshire Hospitals NHS Trust and Hull York Medical School, Kingston-upon-Hull, United Kingdom.
Front Biosci (Landmark Ed). 2011 Jan 1;16(4):1364-87. doi: 10.2741/3794.
Chronic kidney disease has been increasingly recognized as a risk factor for incident heart failure. Despite advances in chronic heart failure treatment, the prognosis remains poor. The annual mortality from all cardiovascular causes in the end stage renal disease population is significantly higher than the general population, accounting for more than half of all deaths in this group. The mechanisms underlying the enhanced susceptibility to myocardial ischemia in chronic kidney disease are not well defined. Traditional cardiovascular risk factors, although common in chronic kidney disease, do not exert the same impact as in the general population. The presence of "renal-specific" non-traditional risk factors including endothelial dysfunction, inflammation, oxidative stress, anaemia, proteinuria and changes in vitamin D metabolism (encompassing the complex interactions of calcium and phosphate metabolism, hyperparathyroidism and vascular calcification) play an important role in cardiovascular disease progression. An increased understanding of the array of metabolic changes/adaptations occurring in uraemic heart disease have allowed one to consider optimal management strategies and to develop new strategies for future management of uraemic heart disease.
慢性肾脏病已日益被认为是心力衰竭事件的一个危险因素。尽管慢性心力衰竭的治疗取得了进展，但预后仍然很差。终末期肾病患者的所有心血管原因的年死亡率明显高于一般人群，占该组所有死亡人数的一半以上。慢性肾脏病患者心肌缺血易感性增强的机制尚未明确。虽然传统心血管危险因素在慢性肾脏病中很常见，但它们的影响与一般人群不同。包括内皮功能障碍、炎症、氧化应激、贫血、蛋白尿和维生素 D 代谢变化（包括钙和磷代谢、甲状旁腺功能亢进和血管钙化的复杂相互作用）在内的“肾脏特异性”非传统危险因素在心血管疾病进展中起着重要作用。对尿毒症性心脏病中发生的一系列代谢变化/适应的深入了解，使得人们能够考虑最佳的管理策略，并为未来的尿毒症性心脏病管理制定新的策略。
