UCL Great Ormond Street Hospital for Children and Institute of Child Health, London, WC1N 3JH, UK.
Pediatr Nephrol. 2021 Aug;36(8):2537-2544. doi: 10.1007/s00467-021-05102-y. Epub 2021 Jun 18.
Cardiovascular disease (CVD) is a life-limiting condition in patients with chronic kidney disease (CKD) and is rapidly progressive, especially in those with stage 5 CKD and on dialysis. Cardiovascular mortality, although reducing, remains at least 30 times higher than in the general pediatric population. The American Heart Association guidelines for cardiovascular risk reduction in high-risk pediatric patients has stratified pediatric CKD patients in the "high risk" category for the development of CVD, with associated pathological and/or clinical evidence for manifest coronary disease before 30 years of age. While improving patient survival is a key priority, other patient-related outcomes, such as psychosocial development, quality of life and growth are of major importance to children and their caregivers. Once vascular damage or calcification has developed, there are no data to suggest that they can be reversed. Treatments such as intensified dialysis and transplantation may attenuate the progression of subclinical cardiovascular disease, but no treatment to date has shown that the inexorable progression of CVD in CKD can be reversed. Thus, our management must focus on early diagnosis and robust preventative strategies to give our patients the best chance of optimal cardiovascular health and survival. In this review, the pathophysiology and importance of preventing the development of CVD in CKD is discussed.
心血管疾病（CVD）是慢性肾脏病（CKD）患者的一种危及生命的疾病，且其进展迅速，尤其是在 5 期 CKD 患者和透析患者中。尽管心血管死亡率有所下降，但仍至少比普通儿科人群高 30 倍。美国心脏协会（AHA）为高风险儿科患者制定的心血管风险降低指南将儿科 CKD 患者分层为 CVD 发病的“高危”类别，其具有明显冠状动脉疾病的病理和/或临床证据，发病年龄在 30 岁之前。虽然提高患者生存率是一个关键的优先事项，但其他与患者相关的结局，如心理社会发展、生活质量和生长，对儿童及其照顾者来说非常重要。一旦发生血管损伤或钙化，就没有数据表明它们可以逆转。强化透析和移植等治疗方法可能会减缓亚临床心血管疾病的进展，但迄今为止，没有任何治疗方法表明 CKD 中 CVD 的不可避免进展可以逆转。因此，我们的治疗必须侧重于早期诊断和强有力的预防策略，以使我们的患者有最佳机会获得最佳心血管健康和生存。在这篇综述中，讨论了 CKD 中 CVD 发生的病理生理学和预防的重要性。
