Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Hypertens Res. 2018 May;41(5):309-319. doi: 10.1038/s41440-018-0025-5. Epub 2018 Mar 12.
Arterial stiffness is an important risk factor for cardiovascular morbidity and mortality in patients with end-stage renal disease (ESRD). Arterial stiffness aggravates cardiovascular risk via multiple pathways, such as augmentation of aortic systolic pressure, subendocardial hypoperfusion, and excess pulsatile energy transmission from macro- to microcirculation. Pathogenesis of the arteriosclerotic process in ESRD is complex and not yet fully understood. Several factors unique to ESRD, such as mineral metabolism disturbances, vascular calcifications, formation of advanced glycation end-products, and acute and chronic volume overload, are proposed to play a particular role in the progression of arteriosclerosis in ESRD. As these and other mechanistic pathways of arterial stiffening in ESRD are elucidated, there is hope that this knowledge will be translated into novel therapeutic interventions targeting arterial stiffness. In the meantime, blood pressure (BP) lowering via strict volume control and appropriate use of antihypertensive drugs is a fundamental step in reversing accelerated arterial stiffening and modifying the cardiovascular risk profile of ESRD patients. In this article, we review the pathogenesis, clinical epidemiology, and therapies targeting arterial stiffness in ESRD, discussing recent advances and high-priority goals of future research in these important areas.
动脉僵硬度是终末期肾病（ESRD）患者心血管发病率和死亡率的一个重要危险因素。动脉僵硬度通过多种途径加重心血管风险，例如增加主动脉收缩压、心肌下灌注不足以及从宏观循环到微循环的脉动能量传递增加。ESRD 中动脉粥样硬化过程的发病机制很复杂，尚未完全了解。一些特有的 ESRD 因素，如矿物质代谢紊乱、血管钙化、晚期糖基化终产物的形成以及急性和慢性容量超负荷，被认为在 ESRD 中动脉粥样硬化的进展中起特殊作用。随着这些以及 ESRD 中动脉僵硬的其他机制途径被阐明，人们希望将这些知识转化为针对动脉僵硬的新的治疗干预措施。在此期间，通过严格的容量控制和适当使用降压药物降低血压（BP）是逆转加速动脉僵硬和改变 ESRD 患者心血管风险特征的基本步骤。在本文中，我们回顾了 ESRD 中动脉僵硬的发病机制、临床流行病学和治疗方法，讨论了这些重要领域的最新进展和未来研究的优先目标。
