Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 168.52
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

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Advances in Clinical and Experimental Medicine

2006, vol. 15, nr 2, March-April, p. 227–232

Publication type: editorial article

Language: English

Early Development and Rapid Progression of Atherosclerosis in Patients with Chronic Kidney Disease

Wczesny rozwój i szybka progresja miażdżycy u pacjentów z przewlekłą chorobą nerek

Stanisław Czekalski1,, Andrzej Oko1,, Krzysztof Pawlaczyk1,

1 Department of Nephrology, Transplantology and Internal Diseases, University of Medical Sciences, Poznań, Poland

Abstract

Chronic kidney disease (CKD) is an important risk factor for cardiovascular disease, due mostly to premature development and accelerated course of atherosclerosis. Apart form traditional risk factors influencing the development of atherosclerosis in general population, the role of the factors associated with endothelial damage, the oxidative stress−altered lipoprotein structure and function and chronic inflammation was recently characterized. It was suggested that activation of local renin−angiotensin system, increased oxidative stress and production of proinflammatory cytokines like interleukin−6 (Il−6) and tumor necrosis factor−α (TNF−α) are probable candidates to play a key role in early stages of CKD. Persistent microalbuminuria and proteinuria are independent risk factors for progression of both renal injury and vascular disease. As kidney function impairment progresses in the course of CKD, the prevalence and magnitude of several non−traditional risk factors for atherosclerosis, such as oxidative stress, endothelial dysfunction, chronic inflammation, accumulation of advanced glycation end−products and other toxic metabolites and vascular calcification increase. In patients with renal failure low serum levels of cholesterol, homocysteine, low blood pressure and malnutrition are associated with increased cardiovascular morbidity and mortality and it was suggested that development of the malnutrition, inflammation, atherosclerosis (MIA) syndrome is involved in the “reverse epidemiology” of cardiovascular complications in patients with end−stage renal disease.

Key words

chronic kidney disease, atherosclerosis, oxidative stress, inflammation, cardiovascular disease

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