ReviewPremature cardiovascular disease in chronic renal failure
Section snippets
CVD among dialysis patients
In the general population, cardiac disease is usually caused by atheromatous lesions in the coronary arteries. However, among patients commencing dialysis, the main cardiac abnormality is left ventricular hypertrophy, which is found in about 75% of them.6 This disorder is often accompanied by other circulatory abnormalities, including ventricular dilatation,6 arterial (and especially aortic) stiffening,7 and coronary atherosclerosis with prominent calcification.8 Clinical manifestations of
Hypertension
Experimental and clinical studies have shown that renal damage can cause hypertension through plasma volume expansion, sodium retention, overactivity of both the sympathetic nervous system and the renin-angiotensin-aldosterone axis, and accumulation of circulating endogenous vasoactive substances.12 Without effective treatment, blood pressure gradually increases as glomerular filtration rate declines,13 while hypertension causes further renal damage and establishes a vicious circle. Early renal
Discussion
Early renal failure is associated with changes in known and suspected cardiovascular risk factors, some of which seem to be a direct result of renal impairment. Higher blood presure, higher LDL-cholesterol concentrations, and lower HDL-cholesterol concentrations are all likely to be of independent causal relevance to coronary-artery disease. Extrapolation from observational studies among middle-aged individuals in the general population suggests that the early exposure to abnormalities of these
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