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Chronic Kidney Disease

Effects on the Cardiovascular System


Ernesto L. Schiffrin, MD, PhD, FRSC, FRCPC; Mark L. Lipman, MD, FRCPC;
Johannes F.E. Mann, MD
Cardiovascular Involvement in General
Medical Conditions

I
t is increasingly apparent that stress, and inflammation.
individuals with chronic Finally, mechanisms that are
kidney disease (CKD) are involved in vascular calcification
more likely to die of often found in CKD and end-
cardiovascular (CV) disease stage renal disease (ESRD) will
(CVD) than to develop kidney be described. Additionally,
failure.1,2 A large cohort study ESRD is associated with several
comprising _130 000 elderly specific complications caused by
subjects the uremic state per se, which
showed that increased incidence can contribute to the
of CV events could be in part development and progression of
related to the fact that persons CVD through volume overload
with renal insufficiency are less with consequent hypertension,
likely to receive appropriate anemia, uremic pericarditis,
cardioprotective treatments.
3 However, beyond the effects and cardiomyopathy. However,
of lack of appropriate these issues will not be
therapy, it is clear that addressed because the
accelerated CVD is prevalent in emphasis will be on CKD before
subjects with CKD. The first part ESRD is reached. In addition, the
of the present review will CV complications associated
therefore focus on the with dialysis will not be
epidemiological links between discussed. The different stages
impairment of CKD according to the level of
of renal function and adverse CV glomerular filtration rate (GFR)
events, between are shown in Table 1. ESRD
albuminuria and CV events, and corresponds to the stage
between serum cystatin C and where patients need renal
CVD. The second part of the replacement therapy (ie, dialysis
present review will address the or renal transplantation),
mechanisms that lead to the whereas stage 1 is mostly
association of renal and CVD, recognized by either
which include hypertension, albuminuria or structural renal
dyslipidemia, activation of the abnormality (eg, hyperechoic
renin-angiotensin system, renal parenchyma on
endothelial dysfunction and the ultrasound). Table 2 provides
role of asymmetric dimethyl the approximate odds ratios
arginine (ADMA), oxidative (univariate) of CVD
according to stages of CKD on
the basis of the literature cited
below. The increase in risk in
comparison to people without
CKD depends on the age of the
population studied: the younger
the person, the higher the SUMMARY:
relative risk. Microalbuminuria
increases the CV risk 2- to 4-
fold.

The article is all about chronic renal disease


its effects to the cardiovascular system. Accelerated
cardiovascular disease is a frequent complication of
renal disease. Chronic kidney disease promotes
hypertension and dyslipidemia, which in turn can
contribute to the progression of renal failure.
Furthermore, diabetic nephropathy is the leading cause
of renal failure in developed countries. Together,
hypertension, dyslipidemia, and diabetes are major
risk factors for the development of endothelial
dysfunction and progression of atherosclerosis.
Inflammatory mediators are often elevated and the
renin-angiotensin system is frequently activated in
chronic kidney disease, which likely contributes
through enhanced production of reactive oxygen species
to the accelerated atherosclerosis observed in chronic
kidney disease. Promoters of calcification are
increased and inhibitors of calcification are reduced,
which favors metastatic vascular calcification, an
important participant in vascular injury associated
with end-stage renal disease. Accelerated
atherosclerosis will then lead to increased prevalence
of coronary artery disease, heart failure, stroke, and
peripheral arterial disease. Consequently, subjects
with chronic renal failure are exposed to increased
morbidity and mortality as a result of cardiovascular
events. Prevention and treatment of cardiovascular
disease are major considerations in the management of
individuals with chronic kidney disease.
REACTION:

It is very important to take really good care of


our kidneys because our kidneys play a big role to our
body which is to filter our body wastes. Nowadays,
cases of CRD is increasing in continue to spread all
over the world. Having discipline to ourselves
regarding our health could be a big help to prevent
diseases because most of us abuse our body that’s why
we had a lot diseases which is developing in our body
and most of them could lead to death. Having a good
health is one of the greatest treasures we could have;
this could make us disease free of such serious
illness. Regarding CRD, I could only say that proper
nutrition and proper care of our kidneys is one of the
important ways to prevent and to eliminate this
disease to occur within us. And what I said earlier is
that, one of the best way to have good health is to
have a self-discipline regarding health care because
we are the one who are deciding whether to have a
disease or not. Living with a healthy lifestyle and
good health is one of the achievable and could have an
satisfying life.

BIBLIOGRAPHY:
http://cinhal.com
http://circ.ahajournals.org
http://circ.ahajournals.org/cgi/reprint/116/1/85
Ernesto L. Schiffrin, MD, PhD, FRSC, FRCPC;
Mark L. Lipman, MD, FRCPC; Johannes F.E. Mann,MD