PURPOSE OF REVIEW: The limited prognosis of patients with chronic kidney disease starts when renal function begins to decline. RECENT FINDINGS: Available interventions did not prove their efficacy. Treatment of dyslipidemia and inflammation by statins was shown to be effective in post-hoc subgroup analyses of large-scale randomized controlled trials in patients with chronic kidney disease stages 2 and 3. So far, randomized controlled trials in dialysis patients (HEMO, ADEMEX, 4D study) and after kidney transplantation (ALERT study) have produced so-called 'negative results'. It is most likely that these trials had limited power to prove the primary hypothesis. It is also probable that cardiac disease in renal patients changes its character from a vascular atherosclerotic to a more complex structural heart disease in combination with stiff arteries (arteriosclerosis). Clinically, this leads to a high proportion of sudden cardiac deaths: of 270 cardiac deaths in the 4D trial, 160 were of sudden cardiac origin. A complex pathogenetic process and a number of new emerging cardiovascular disease risk factors in the setting of high-grade inflammation/infection are proposed as being responsible. SUMMARY: This review focuses on outcome variables in diabetic hemodialysis patients with special focus on risk factors such as inflammation and dyslipidemia.
PURPOSE OF REVIEW: The limited prognosis of patients with chronic kidney disease starts when renal function begins to decline. RECENT FINDINGS: Available interventions did not prove their efficacy. Treatment of dyslipidemia and inflammation by statins was shown to be effective in post-hoc subgroup analyses of large-scale randomized controlled trials in patients with chronic kidney disease stages 2 and 3. So far, randomized controlled trials in dialysis patients (HEMO, ADEMEX, 4D study) and after kidney transplantation (ALERT study) have produced so-called 'negative results'. It is most likely that these trials had limited power to prove the primary hypothesis. It is also probable that cardiac disease in renal patients changes its character from a vascular atherosclerotic to a more complex structural heart disease in combination with stiff arteries (arteriosclerosis). Clinically, this leads to a high proportion of sudden cardiac deaths: of 270 cardiac deaths in the 4D trial, 160 were of sudden cardiac origin. A complex pathogenetic process and a number of new emerging cardiovascular disease risk factors in the setting of high-grade inflammation/infection are proposed as being responsible. SUMMARY: This review focuses on outcome variables in diabetic hemodialysispatients with special focus on risk factors such as inflammation and dyslipidemia.
Authors: Sylvia P B Ramirez; Justin M Albert; Margaret J Blayney; Francesca Tentori; David A Goodkin; Robert A Wolfe; Eric W Young; George R Bailie; Ronald L Pisoni; Friedrich K Port Journal: J Am Soc Nephrol Date: 2009-04-08 Impact factor: 10.121