The Assessment of Nontraditional Risk Factors Cardiovascular Pathology and Their Drug Correction in Program Hemodialysis Patients
Fifty percent of all fatal cases in program hemodialysis patients are due to cardiovascular pathology. Dialysis patients are exposed to both traditional risk factors of cardiovascular diseases, and nontraditional factors related to uremia and dialysis (endothelial dysfunction, oxidative stress, anemia, chronic inflammation, and calcium phosphorus metabolic imbalance).
There considered the mechanisms of negative effects of nonconventional risk factors on cardiovascular system. The role of endothelial dysfunction (the imbalance of endothelium synthesized factors) in cardiovascular pathology is studied most extensively. In some cases, endothelial dysfunction in dialysis patients is followed by structural changes of vascular wall and clinical manifestations of cardiac pathology. Despite the fact that mechanisms of endothelium damage in uremia and hemodialysis are not studied thoroughly, chronic hemodialysis patients are known to have increased lipid peroxidation activity and conditions for oxidative stress development – universal mechanisms of endothelial damage. Anemia characteristic of dialysis patients also increases oxidative stress, mainly due to the termination of erythropoietin synthesis by kidneys. In hemodialysis chronic inflammation occurs frequently. One of the possible mechanisms of inflammation impact on cardiovascular system is endothelial damage. Calcium phosphorus metabolic imbalance also has negative effect on vascular endothelium. Thus, almost every “nontraditional” risk factor of cardiovascular pathology in hemodialysis is implemented through endothelium damage.
Current data on drug correction of endothelial dysfunction in dialysis patients are given. This pharmacotherapy line is mentioned to be just under development now. Actually, the application of angiotensin converting enzyme inhibitors, angiotensin receptor blockers, calcium channel-blocking agents, and statins are the most prospective.
