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Chronic kidney disease as a cardiovascular risk factor: lessons from kidney donors
Journal of the American Society of Hypertension Pub Date : 2018-05-09 , DOI: 10.1016/j.jash.2018.04.010
Anna M. Price , Nicola C. Edwards , Manvir K. Hayer , William E. Moody , Richard P. Steeds , Charles J. Ferro , Jonathan N. Townend

Chronic kidney disease (CKD) is a major risk factor for cardiovascular disease but is often associated with other risks such as diabetes and hypertension and can be both a cause and an effect of cardiovascular disease. Although epidemiologic data of an independent association of reduced glomerular filtration rate with cardiovascular risk are strong, causative mechanisms are unclear.

Living kidney donors provide a useful model for assessing the “pure” effects of reduced kidney function on the cardiovascular system. After nephrectomy, the glomerular filtration rate ultimately falls by about one-third so many can be classified as having chronic kidney disease stages 2 or 3. This prompts concern based on the data showing an elevated cardiovascular risk with these stages of chronic kidney disease. However, initial data suggested no increase in adverse cardiovascular effects compared with control populations. Recent reports have shown a possible late increase in cardiovascular event rates and an early increase in left ventricular mass and markers of risk such as urate and albuminuria. The long-term significance of these small changes is unknown. More detailed and long-term research is needed to determine the natural history of these changes and their clinical significance.



中文翻译:

慢性肾脏病是心血管疾病的危险因素:来自肾脏捐赠者的经验教训

慢性肾脏疾病(CKD)是心血管疾病的主要危险因素,但通常与其他风险(如糖尿病和高血压)相关,并且既可能是心血管疾病的起因也可能是疾病。尽管有关肾小球滤过率降低与心血管疾病风险独立相关的流行病学数据很强,但其致病机制尚不清楚。

活体肾脏供体为评估肾功能下降对心血管系统的“纯”作用提供了有用的模型。肾切除术后,肾小球滤过率最终下降约三分之一,因此可归类为患有慢性肾脏疾病2或3期的肾小球滤过率。基于数据显示慢性肾脏病这些阶段的心血管风险升高,这引起了人们的关注。但是,初步数据表明,与对照组相比,心血管不良反应没有增加。最近的报道显示,心血管事件发生率可能会增加,而左心室质量和风险指标(如尿酸盐和蛋白尿)可能会提前增加。这些小变化的长期意义尚不清楚。

更新日期:2018-05-09
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