Cardiovascular Disease in End-stage Renal Disease

Cardiovascular disease is the leading cause of morbidity and mortality in patients with end-stage renal disease. It accounts for nearly half of the mortality in end-stage renal disease patients on maintenance dialysis treatment. The spectrum of cardiovascular disease is diverse, including vascular disease and myocardial disease, and the two commonly coexist and are interrelated with each other. Apart from considering the traditional Framingham risk factors, there is increasing recognition of the importance of non-traditional risk factors in predisposing patients with end-stage renal disease to this high incidence of cardiovascular complications, including excessive calcium phosphorus load, hyperparathyroidism, anemia, hemodynamic overload, inflammation, increased asymmetric dimethylarginine and oxidative stress. Cardiovascular disease in end-stage renal disease patients commonly manifests as ischemic heart disease or acute coronary syndrome, stroke, peripheral vascular disease and congestive heart failure. According to the United States Renal Data System, the annual incidence of new-onset ischemic heart disease, stroke, peripheral vascular disease and congestive heart failure was estimated to be approximately 5%, 1%, 7% and 7%, respectively. In order to improve the cardiovascular outcomes of end-stage renal disease patients receiving maintenance dialysis therapy, a better understanding of the nature and severity of cardiovascular disease as well as risk factors associated with the different cardiovascular complications is required.