Abstract

Cardiovascular disease (CVD) is highly prevalent in patients suffering from chronic kidney disease (CKD). The risk of patients with CKD developing CVD is manifested already in the early stages of CKD development. The impact of declined kidney function on increased cardiovascular risk and the underlying mechanisms are complex and multifactorial. This review discusses the impact of (a) traditional cardiovascular risk factors such as smoking, dyslipidemia, diabetes, and hypertension as well as (b) CKD-specific pathophysiological and molecular mechanisms associated with an increased cardiovascular risk. The latter include uremic toxins, post-translational modifications and uremic lipids, innate immune cell activation and inflammation, oxidative stress, endothelial cell dysfunction, increased coagulation and altered platelet responses, vascular calcification, renin–angiotensin–aldosterone-system (RAAS) and sympathetic activation, as well as anemia. Unraveling the complex interplay of different risk factors, especially in the context of patient subcohorts, will help to find new therapeutic approaches in order to reduce the increased cardiovascular risk in this vulnerable patient cohort.

中文翻译：

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慢性肾病患者心血管风险增加

摘要

心血管疾病（CVD）在慢性肾病（CKD）患者中非常普遍。CKD 患者发展为 CVD 的风险在 CKD 发展的早期阶段就已经显现出来。肾功能下降对心血管风险增加的影响及其潜在机制是复杂且多因素的。本综述讨论了 (a) 传统心血管危险因素（如吸烟、血脂异常、糖尿病和高血压）以及 (b) 与心血管风险增加相关的 CKD 特异性病理生理学和分子机制的影响。后者包括尿毒症毒素、翻译后修饰和尿毒症脂质、先天免疫细胞激活和炎症、氧化应激、内皮细胞功能障碍、凝血增加和血小板反应改变、血管钙化、肾素-血管紧张素-醛固酮系统（RAAS）和交感神经系统激活，以及贫血。揭示不同危险因素之间复杂的相互作用，特别是在患者亚群的背景下，将有助于找到新的治疗方法，以减少这一弱势患者群中增加的心血管风险。