Aoki Jiro, Ikari Yuji
Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
Department of Cardiovascular Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
Ann Vasc Dis. 2017 Dec 25;10(4):327-337. doi: 10.3400/avd.ra.17-00051.
Cardiovascular disease is a major concern for patients with end-stage renal disease (ESRD), especially those on hemodialysis. ESRD patients with coronary artery disease often do not have symptoms or present with atypical symptoms. Coronary lesions in ESRD patients are characterized by increased media thickness, infiltration and activation of macrophages, and marked calcification. Several studies showed worsened clinical outcomes after coronary revascularization, which were dependent on the severity of renal dysfunction. ESRD patients on hemodialysis have the most severe renal dysfunction; thus, the clinical outcomes are worse in these patients than in those with other types of renal dysfunction. Medications for primary or secondary cardiovascular prevention are also insufficient in ESRD patients. Efficacy of drug-eluting stents is inferior in ESRD patients, compared to the excellent outcomes observed in patients with normal renal function. Unsatisfactory outcomes with trials targeting cardiovascular disease in patients with ESRD emphasize a large potential to improve outcomes. Thus, optimal strategies for diagnosis, prevention, and management of cardiovascular disease should be modified in ESRD patients.
心血管疾病是终末期肾病（ESRD）患者，尤其是接受血液透析患者的主要担忧。患有冠状动脉疾病的ESRD患者通常没有症状或表现出非典型症状。ESRD患者的冠状动脉病变特征为中膜厚度增加、巨噬细胞浸润和激活以及明显钙化。多项研究表明，冠状动脉血运重建后临床结局恶化，这取决于肾功能不全的严重程度。接受血液透析的ESRD患者肾功能不全最为严重；因此，这些患者的临床结局比其他类型肾功能不全的患者更差。ESRD患者用于一级或二级心血管预防的药物也不足。与肾功能正常患者观察到的良好结局相比，药物洗脱支架在ESRD患者中的疗效较差。针对ESRD患者心血管疾病的试验结果不理想，强调了改善结局的巨大潜力。因此，应针对ESRD患者修改心血管疾病的最佳诊断、预防和管理策略。
