/Chronic kidney disease is closely related to cardiovascular disease

Chronic kidney disease is closely related to cardiovascular disease

author:admin       pubdate:2017-08-11 15:11

Chronic kidney disease is closely related to cardiovascular disease

Chronic kidney disease (CKD) is a public health problem worthy of attention, the incidence gradually increased, and consequences and serious economic problems. At present, scholars pay more and more attention to CKD nephropathy and cardiovascular disease (CVD) relationship, CKD is not only related to CVD, and the ratio of acute renal failure in progress are more likely to die cardiovascular disease, CVD is the most common cause of death in CKD.

First, the epidemiological characteristics of CKD in CVD

Epidemiological data showed that the general population of.HOPE incidence and mortality in patients with CKD CVD were significantly higher than those of the same age in serum creatinine than 1.4mg/dL patients, the incidence of CVD was 10.6%; CCP study indicated that the serum creatinine was 1.5mg/dL in the population, the incidence of CVD was 36.7%; and the results of the CARE study, creatinine clear rate of less than 75ml/min of the population, the incidence of CVD was 41.1%. while investigating the different research data of different populations, but the results show that the CKD population CVD incidence is significantly increased. In CKD patients, the mortality rate caused by CVD is 10~30 times higher than normal human renal function. In end-stage renal failure in hemodialysis patients with CVD resulted in high mortality rate of up to 50%.Culleton on the 6233 community patients with mild renal dysfunction (serum creatinine was 120 ~ 265umol/L) for 15 Results of a prospective study in 2009 showed that this group of patients the incidence of CVD is 2 times that of the patients without renal disease in patients with.ESRD CVD have higher rates, start dialysis in patients, 75% patients with LVH, 40% patients with CAD, CHF. (hemodialysis or peritoneal dialysis patients) CVD annual mortality rate of 9%, the general population is 30. of China's Shanghai region in 1093 cases of CKD patients from 4 to 5 survey period showed: the incidence of CVD was 86%, CVD related mortality accounted for 44.2%. of five provinces and cities nationwide Hou FF autonomous region of 1239 cases of patients with CKD CVD prevalence survey results showed that: the most common CVD is LVH, the total incidence rate was 58.5%, with CKD 5 and LVH 65%. in our hospital according to the patient's clinical manifestations, biochemical indexes and chest X-ray, electrocardiogram, echocardiography results of CKD patients with CVD (including CAD, LVH and CHF) the prevalence survey results show C. The prevalence of VD were: CKD 1 CKD 5.13%, 2 CKD 17.24%, 3 CKD 27.86%, 4 CKD 26.92%, 5 CVD 47.49%, CKD 1 in the period that has occurred, with the progression of CKD and its prevalence is rising. Dialysispatients CVD prevalence was higher than CKD in each period.

Two, risk factors for CKD in patients with CVD

The complications and mortality in patients with CKD CVD why high, mainly because in CKD patients there are two CVD risk factors: the danger that the traditional risk factors and non-traditional factors.1, traditional risk factors include age, gender, hypertension, high blood lipids (LDL increased, HDL decreased), diabetes, smoking, obesity menopause, reduced physical activity, mental stress and family history of CVD.

2, including non conventional factors: the rate of decline in GFR, proteinuria, anemia, malnutrition, hypercoagulable state, volume overload, lipid metabolism disorders, disorders of calcium and phosphorus metabolism of vascular calcification, oxidative stress, inflammation, RAS activity increased.

3, "new" and the development of atherosclerosis risk factors: the main non traditional risk factors related: high homocysteine, oxidative stress, lipid metabolism and inflammatory reaction; microalbuminuria, GFR decreased.

Three, CKD is associated with inflammation and oxidative stress

Micro inflammatory state: the theory of population health and CKD of non dialysis and patients found with C reactive protein (CRP) and IL-6 as a marker of inflammation, even within the normal range slightly elevated CVD may also suggest future persistent mild inflammatory activities associated with subclinical atherosclerosis, thus forming a "the theory of micro inflammation. Inflammation of the artery itself has a significant role in lipoprotein movement, inflammatory mediators such as TNF- alpha, IL-1, macrophage colony-stimulating factor can increase the binding of LDL and endothelial, smooth muscle cells, and endothelial cells. In the process of injury in recent years that atherosclerosis is a chronic inflammatory disease, patients advanced CKD is a ubiquitous micro inflammatory state, cytokines and mediators of inflammation and atherosclerosis is closely related to the formation of the body.

Oxidative stress: oxidative stress is important in biological molecules after injury results, reduce the antioxidant activity in plasma from oxygen free radicals before increasing and / or the defence function of free radical damage to its.CKD, antioxidant dialysis, vitamin C, vitamin E loss, erythrocyte membrane on the elevated levels of malondialdehyde, glutathione level decreased, plasma and erythrocyte superoxide dismutase (SOD) and glutathione peroxidase activity were decreased, the oxidative stress in CKD patients was enhanced to produce final oxidation product characteristic, such as oxidized low density lipoprotein (oxLDL), which further increases VCAM-1, the expression of ICAM-1 and MCP-1, enhance the adhesion of leukocytes to vascular endothelial cells and migration, allowing easy access to the site of injury, eventually causing inflammation in patients with.CKD body memory in the oxidant / antioxidant imbalance That is, ROS generation increased antioxidant activity and reducing system, increased levels of oxidative stress. Studies have shown that CKD patients with deterioration of renal function and oxidative stress markers in the blood of advanced oxidation protein products (AOPP) and asymmetric two methionine (ADMA) levels increased, while the AOPP and ADMA levels and CKD in patients with atherosclerosis closely related.

Four, microalbuminuria, GFR decreased with CVD

According to a survey of 23964 patients in Britain: microalbuminuria (MAU) is a risk factor of absolute CVD. In another study, researchers in 840 cases of adult onset diabetes patients were followed up for 12 years, found that patients with MAU compared with patients without MAU, the relative risk of death CVD death is 1.84, and proteinuria in patients with CVD relative risk of death was 2.61, MAU and CVD were significantly related to proteinuria and mortality of.HOPE, PREVENT and MONICA studies found that MAU is a risk factor for cardiovascular adverse events, LIFE, UKPDS and IRMA2 showed that reduced MAU helps to reduce the incidence of adverse cardiovascular.MAU the event is a sign of reaction in heart and kidney of small vessel disease, MAU is currently considered as a risk indicator of prognosis in diabetic patients CVD and other lethal factors, can be explained by the following points: (1) MAU inpidual traditional risk factors of a higher incidence (2) MAU could reflect abnormal endothelial function, increased vascular permeability, abnormal coagulation and fibrinolysis system; (3) related to inflammatory markers; (4) more prone to end organ damage

GFR and CVD decreased and risk factors increased there is a relationship between.GFR decrease, systolic blood pressure, total cholesterol and HDL-C changed more significantly at the same time, left ventricular hypertrophy, diabetes, ischemic heart disease and heart failure rate higher. A recent study found that renal function and coronary artery disease severity, such as chest pain occurred and after angioplasty women, elevated serum creatinine were independent risk index of coronary artery disease. In addition, GFR decreased CVD related to outcome. Especially in the high risk population, GFR decline was the outcome of CVD and various factors lead to death. Independent pre examine factor analysis for the following reasons: (1) is associated with increased CVD than traditional risk factors; (2) may lead to the traditional risk factors (hypertension, dyslipidemia) deteriorated; (3) GFR may be a marker of vascular disease severity; (4) decrease in GFR patients rarely receive treatment, such as aspirin, anti ACEI. Platelets, thrombolysis, or PTCA may benefit from receiving such treatment. (5) GFR decline may itself be a risk factor for progression of myocardial remodeling and cardiac dysfunction

To sum up, there are a variety of risk factors, CVD, CKD and CVD are closely related to.CKD in patients with GFR and CVD risk factors assessment, response to CKD monitoring, then seek prevention and treatment measures, so that patients can get more benefits.

 

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