Kronik Böbrek Hastalıklarında Kardiyovasküler Risk

Kronik böbrek hastalıklarında risk faktörleri olarakkardiyovasküler hastalık, diyabet, hipertansiyon veobezite gösterilmektedir. Son dönem böbrek hastalığıolanlarda morbidite ve mortalitenin başlıca nedeni vetüm ölümlerin %50’sini kardiyovasküler hastalıklar(koroner kalp hastalığı, serebrovasküler hastalık, periferikvasküler hastalık ve kalp yetmezliği gibi) olşturmaktadır. Diyaliz tedavisi gören 25-35 yaşları aras›ndakikişilerde kardiyovasküler hastal›k 500 katı, 85 yaşve üzerindeki kişilerde ise 5 katı daha fazladır. KBHolan hastalarda GFR azalırken, hormonal, metabolikya/ya da trombojenik faktörlerdeki anormallikler,KVH başlangıcı ve alevlenmesinde önemli bir rol oynamaktadır. Kronik böbrek hastalığı (KBH) olan kiflilerdehem “geleneksel” hem de “geleneksel olmayan”(kronik böbrek hastalığı ile ilgili) KVH risk faktörleriartmıştır. Bu makalede “değiştirilebilir” özelliği nedeniyleKBH’n›n tüm safhalarında geleneksel risk faktörleri(dislipidemi, hipertansiyon, diyabetes mellitus, kötüglisemi kontrol, sigara içme ve bedensel hareketsizlikgibi), risk faktörlerin görülme sıklığı, KVH ile riskfaktörleri arasındaki ilişkileri ve risk faktörlerinin tedavisiüzerinde durulmaktadır.

Anahtar Kelimeler:

Kronik böbrek hastalığı, Kardiyovasküler risk, Geleneksel risk faktörleri.

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1. Center of Disease Control. Prevalence of Chronic Kidney Disease and Associated Risk Factors. United States, 1999—2004. March 2, 2007 / 56 (08);161-165.
2. Schoolwerth AC, Engelgau MM, Hostetter TH, et al. Chronic kidney disease: a public health problem that needs a public health action plan. Prev Chronic Dis 2006; 3:A57.
3. Levey AS, Coresh J, Balk E, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003;139:137-47.
4. Gelber RP, Kurth T, Kausz AT, et al. Association between body mass index and CKD in apparently healthy men. Am J Kidney Dis 2005;46:871--80.
5. Bruce F. Culleton, Brenda R. Hemmelgarn (2003) Is Chronic Kidney Disease a Cardiovascular Disease Risk Factor? Seminars In Dialysis 16 (2), 95–100.
6. National Kidney Foundation, KDOQI Working Group: The definition, evaluation and classification of chronic kidney disease. Am J Kidney Dis 2(suppl 1): 2002.
7. U.S. Renal Data System: USRDS 1997 Annual Data Report. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 1997.
8. National Kidney Foundation: K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Executive Summary. New York: National Kidney Foundation, 2002
9. K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. Part 7. Stratification Of Risk For Progression Of K›dney D›sease And Development Of Cardiovascular Disease Guideline 15. Association Of Chronic Kidney Disease With Cardiovascular Disease. E:\renal failure cv risk\KDOQI CKD Guidelines.htm.
10. K/Doqi Clinical Practice Guidelines For Chronic Kidney Disease: Evaluation, Classification, And Stratification. Part 3. Chron›c K›dney D›- sease As A Publ›c Health Problem. E:\KDOQI CKD Guidelines.htm
11. Levin A. Clinical Epidemiology of Cardiovascular Disease in Chronic Kidney Disease Prior to Dialysis. Seminars In Dialysis, 2003; 16 (2), 101–105.
12. U.S. Renal Data System, USRDS 2002 Annual Data Report, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, 2002.
13. Levin A, Djurdjev O, Barrett B, et al. Cardiovascular disease in patients with chronic kidney disease: getting to the heart of the matter. Am J Kidney Dis 2001; 38: 1398–1407,
14. Sarnak MJ, Coronado BE, Greene T et al. Cardiovascular disease risk factors in chronic renal insufficiency. Clin Nephrol 2002; 57: 327–335.
15. KasiskeBL: Hyperlipidemia in patients with chronic renal disease. Am J Kidney Dis 1998; 32: 142–156.
16. Kasiske BL, Chakkera HA, Roel J: Explained and unexplained ischemic heart disease risk after renal transplantation. J Am Soc Nephrol 2000; 11: 1735–1743.
17. Saltissi D, Morgan C, Rigby RJ, et al. Safety and efficacy of simvastatin in hypercholesterolemic patients undergoing chronic renal dialysis. Am J Kidney Dis 2002; 39: 283–290.
18. Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). JAMA 1993; 269: 3015–3023.
19. Coresh J, Wei GL, McQuillan G, et al. Prevalence of high blood pressure and elevated serum creatinine level in the United States: findings from the third National Health and Nutrition Examination Survey (1988–1994). Arch Intern Med 2001; 161: 1207–1216.
20. Buckalew VMJr, Berg RL, Wang SR, et al. Prevalence of hypertension in 1,795 subjects with chronic renal disease: the modification of diet in renal disease study baseline cohort. Modification of Diet in Renal Disease Study Group. Am J Kidney Dis 1996; 28: 811–821.
21. Kasiske BL, Kalil RS, Ma JZ, et al. Effect of antihypertensive therapy on the kidney in patients with diabetes: a meta-regression analysis. Ann Intern Med 118: 129–138, 1993;
22. Mann JF, Gerstein HC, Pogue J, et al. Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial. Ann Intern Med 2001; 134: 629–636.
23. The sixth report of the Joint National Committee on prevention, detection evaluation, and treatment of high blood pressure. Arch Intern Med 1997; 157: 2413–2446,
24. Bakris GL, Williams M, Dworkin L, et al. Preserving renal function in adults with hypertension and diabetes: a consensus approach. National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group. Am J Kidney Dis 2000; 36: 646–661.
25. Aakhus S, Dahl K, Wideroe TE. Cardiovascular morbidity and risk factors in renal transplant patients. Nephrol Dial Transplant 1999; 14: 648–654.
26. Mailloux LU, Levey AS. Hypertension in patients with chronic renal disease. Am J Kidney Dis 1998; 32: 120–141.
27. Longenecker JC, Coresh J, Powe NR, et al. Traditional cardiovascular disease risk factors in dialysis patients compared with the general population: the CHOICE study. J Am Soc Nephrol 2002; 13: 1918–1927.
28. Mailloux LU, Haley WE. Hypertension in the ESRD patient: pathophysiology, therapy, outcomes, and future directions. Am J Kidney Dis 1998; 32: 705–719.
29. Salem MM. Hypertension in the hemodialysis population: a survey of 649 patients. Am J Kidney Dis 1995; 26: 461–468.
30. Foley RN, Parfrey PS, Harnett JD, et al. Impact of hypertension on cardiomyopathy, morbidity and mortality in end-stage renal disease. Kidney Int 1996; 49: 1379–1385.
31. Kawamura M, Fijimoto S, Hisanaga S, et al. Incidence, outcome, and risk factors of cerebrovascular events in patients undergoing maintenance hemodialysis. Am J Kidney Dis 1998; 31: 991–996.
32. Charra B, Calemard E, Ruffet M, et al. Survival as an index of adequacy of dialysis. Kidney Int 1992; 41: 1286–1291.
33. Coresh J, Longenecker JC, MillerER III, et al. Epidemiology of cardiovascular risk factors in chronic renal disease. J Am Soc Nephrol 1998; 9: 24–30.
34. Kasiske BL, KlingerD. Cigarette smoking in renal transplant recipients. J Am Soc Nephrol 2000; 11: 753–759.
35. Cheung AK, Sarnak MJ, Yan G, et al. Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients. Kidney Int 2000; 58: 353–362.
36. Beto JA, Bansal VK. Interventions for other risk factors: tobacco use, physical inactivity, menopause, and homocysteine. Am J Kidney Dis 1998; 5(suppl 3):172–184.
37. Anderson JE, Jorenby DE, Scott WJ, et al. Treating tobacco use and dependence: an evidence-based clinical practice guideline for tobacco cessation. Chest 2002; 121: 932–941.
38. Aronoff GR, Berns JS, Brier ME, et al. Drug Prescribing in Renal Failure, 4th ed.: American College of Physicians, Philadelphia, PA, 1999.
39. Stephenson JM, Kenny S, Stevens LK, et al. Proteinuria and mortality in diabetes: the WHO Multinational Study of Vascular Disease in Diabetes. Diabet Med 1995; 12: 149–155.
40. Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications Trial. The Diabetes Control and Complications (DCCT) Research Group. Kidney Int 1995; 47: 1703–1720.
41. Barbosa J, Steffes MW, Sutherland DE, et al. Effect of glycemic control on early diabetic renal lesions. A 5-year randomized controlled clinical trial of insulin-dependent diabetic kidney transplant recipients. JAMA 1994; 272: 600–606.
42. Collins AJ, Li S, Ma JZ, et al. Cardiovascular disease in end-stage renal disease patients. Am J Kidney Dis 2001; 38: 26–29.
43. Manske CL. Hyperglycemia and intensive glycemic control in diabetic patients with chronic renal disease. Am J Kidney Dis 1998; 32: 157–171.
44. Painter P, Messer-Rehak D, Hanson P, et al. Exercise capacity in hemodialysis, CAPD, and renal transplant patients. Nephron 1986; 42: 47–51.
45. Sietsema KE, Hiatt WR, Esler A, et al. Clinical and demographic predictors of exercise capacity in end-stage renal disease. Am J Kidney Dis 2002; 39: 76–85.
46. Surgeon General's report on physical activity and health. From the Centers for Disease Control and Prevention. JAMA 1996; 276: 522.