CVD in CKD: Focus on the dyslipidemia problem

Abstract

Increased cardiovascular morbidity and mortality have been extensively documented in patients with chronic kidney disease (CKD). Notably, cardiovascular risk gradually increases with increasing stages of CKD, being the highest among patients with end-stage renal disease. Although the role of hyperlipidemia in the development of cardiovascular disease (CVD) in the general population has been efficiently documented, this relationship has been difficult to establish in patients with CKD. Indeed, non-traditional cardiovascular risk factors (inflammation, increased oxidative stress, vascular calcification, endothelial dysfunction, and anemia) confound the association of dyslipidemia and CVD in the CKD setting. Moreover, lipoprotein abnormalities in CKD substantially differ from those in the general population, with hypertriglyceridemia being the primary characteristic, whereas total and low-density lipoprotein cholesterol are normal or low. To further complicate things, pathologic findings of arterial lesions in CKD consist of calcium-rich atherosclerotic plaques, whereas in classic atherosclerotic disease lipid-laden atheromatous or fibroatheromatous plaques are detected, implying a different pathogenetic mechanism of CKD atherosclerotic disease.