Vascular effects of inflammation and oxidative stress in ckd

Abstract

Chronic kidney disease (CKD) affects about 10 % of the general population [1] and, with disease progression, increasingly associates with excessive mortality risk, mainly due to cardiovascular complications [2]. Evidence suggests that CKD is associated with premature aging [3]. In end-stage renal disease (ESRD) patients on dialysis, the annual mortality rate, 10–20 % depending on the country/region, is comparable to that of patients with some common forms of metastatic cancer [4]. Even a slight decrease in glomerular filtration rate (GFR) predicts cardiovascular risk [5]. Although traditional (, Framingham) risk factors, such as age, smoking, dyslipidemia, hypertension, and diabetes mellitus are common and predict cardiovascular mortality in CKD patients, especially in patients with mild to moderate CKD, so called novel risk factors, such as inflammation and oxidative stress, are also highly prevalent in these patients and are major driving forces for the uremic phenotype, which commonly includes both premature cardiovascular disease and protein-energy wasting (PEW) [6]. The risk factor profile is markedly different in the uremic milieu and chemical alterations of molecules in the uremic milieu may transform them and change their pro-atherogenic potential. This chapter focuses on the impact of inflammation and oxidative stress on cardiovascular complications in CKD population.