The clinical epidemiology of cardiac disease in chronic renal failure.

The annual mortality from cardiovascular disease in dialysis patients is substantially higher than in the general population (Figure 1) (1). The 5-yr survival of men .64 yr old starting dialysis is worse than that of men with colon cancer and prostate cancer (2). The 5-yr survival of women .64 yr old starting dialysis is worse than that of women with breast cancer and colon cancer (2). About half the deaths in dialysis patients are attributed to cardiovascular disease (2). Hospitalizations of dialysis patients occur frequently and about one-third are the result of cardiovascular disease (2). Despite enormous morbidity and premature mortality resulting from cardiovascular disease, it is only recently that the clinical epidemiology of cardiovascular disease in chronic renal failure has become a major focus of nephrology research. A task force convened by the National Kidney Foundation has considered whether strategies for prevention and treatment of cardiovascular disease in the general population are applicable in patients with chronic renal disease. Two target conditions (coronary artery disease and left ventricular hypertrophy) and four target populations (chronic renal insufficiency, hemodialysis, peritoneal dialysis, and renal transplantation) were considered. Detailed reports are available in a supplement of the American Journal of Kidney Diseases (3). The major focus was on traditional cardiac risk factors identified in the general population, including hyperlipidemia, hypertension, diabetes mellitus, tobacco use, menopause, and physical inactivity. In addition, a recent volume of Seminars in Dialysis was devoted to consideration of potential uremia-related risk factors (4). These included risk factors altered by the uremic state, such as dyslipidemia, prothrombotic factors, hyperhomocysteinemia, and also risk factors characteristic of chronic uremia, such as hemodynamic overload, anemia, increased oxidant stress, hypoalbuminemia, and divalent ion abnormalities (Table 1).