Novos fatores de risco cardiovascular

A mortalidade dos pacientes com doenca renal cronica, quando comparados a populacao em geral, e inaceitavelmente alta, preponderando os eventos cardiovasculares. Indubitavelmente, portadores de doenca renal cronica tem grande prevalencia dos fatores de risco tradicionais para doenca coronariana. Contudo, mesmo apos a estratificacao para esses fatores, a mortalidade da populacao dialitica ainda e 10 a 20 vezes superior a da populacao geral. Numerosos estudos tem demonstrado que pacientes com doenca renal cronica apresentam fatores de risco adicionais relacionados a doenca renal, dentre os quais: alteracoes do metabolismo de calcio e fosforo, anemia, estresse oxidativo, disfuncao endotelial e inflamacao. Estima-se que 30% a 50% dos pacientes no periodo pre-dialitico, bem como em hemodialise e dialise peritoneal, tenham evidencia sorologica de ativacao da resposta inflamatoria, caracterizada por elevacao dos niveis sericos de proteina C-reativa. No final da decada de 1990, a partir da observacao da elevada prevalencia de ma nutricao, inflamacao e aterosclerose em pacientes com doenca renal cronica, sugeriu-se que o sinergismo entre diferentes mecanismos, tais como a ma-nutricao, o estresse oxidativo e a ativacao da resposta inflamatoria, associado a predisposicao genetica seriam um dos principais determinantes do rapido desenvolvimento da doenca aterosclerotica em pacientes uremicos. Chronic kidney disease patient mortality, when compared with the general population, is unacceptably high, the most common complication being cardiovascular events. Undoubtedly, chronic kidney disease patients present high prevalence of traditional risk factors for coronary diseases. However, even after stratifying these factors, the mortality of the dialyzed population is still 10 to 20 times higher than that of general population. Many studies have shown that chronic kidney disease patients have additional risk factors related to renal disease such as alterations in phosphorus and calcium metabolism, anemia, oxidative stress, endothelial dysfunction and inflammation. Between 30% and 50% of patients during the pre-dialysis period and also undergoing hemodialysis and peritoneal dialysis are estimated to present serological evidence of an activated inflammatory response, characterized by an increase in the CRP serum levels. At the end of the 1990's, a high prevalence of malnutrition, inflammation and atherosclerosis was observed in chronic kidney disease patients, suggesting that different mechanisms, such as malnutrition, inflammation, oxidative stress and genetic components were synergistically involved in the atherosclerosis rapidly development in chronic kidney disease.