The epidemic of cardio-vascular disease in renal failure: where does it come from, where do we go?

Cardio-vascular disease and death are among the most important medical and socio-economic challenges of the 21st century. Renal failure, a major medical problem per se, gives rise to an accelerated and strongly magnified model of atherogenesis and vascular damage. Already with a minor decrease in renal function, coronary and vascular risk are increased and play a role next to classical risk factors such as male gender, diabetes mellitus, hypercholesterolemia or smoking. The impact of renal failure on cardio-vascular risk remains present even after correction for these traditional risk factors. This suggests that factors specifically related to renal failure play a role. Atheromatosis is currently considered as an inflammatory disorder. Renal failure gives rise to enhanced inflammatory parameters. However, the atherogenic factors related to this inflammation remain largely unknown. Hence, the condition of renal failure may be helpful to answer this question. According to recent data from the USA, close to 5% of the general population (11% of those older than 65 without diabetes or hypertension) has a renal function which is decreased by at least 50%, but other analyses come up with even higher figures. Better identification of the factors at play in this population, optimized secondary preventive actions similar to those applied in diabetics, and timely screening and therapy will be helpful to improve quality of life and reduce socio-economic burden in this population.