Abstract
Chronic kidney disease (CKD) and cardiac insufficiency often co-exist, particularly in uremic patients on hemodialysis (HD). The occurrence of abnormal renal function in patients with cardiac insufficiency is often indicative of a poor prognosis. It has long been established that in patients with cardiac insufficiency, poorer renal function tends to indicate poorer cardiac mechanics, including left atrial reserve strain, left ventricular longitudinal strain, and right ventricular free wall strain (Unger et al., Eur J Heart Fail, 2016, 18(1), 103–12). Similarly, patients with chronic kidney disease, particularly uremic patients on HD, often have cardiovascular complications in addition to abnormal endothelial function with volume overload, persistent inflammatory states, calcium overload, and imbalances in redox responses. Cardiac insufficiency due to uremia is therefore mainly due to multifaceted non-specific pathological changes rather than pure renal insufficiency. Several studies have shown that the risk of adverse cardiovascular events is greatly increased and persistent in all patients treated with HD, especially in those who have just started HD treatment. Inflammation, as an important intersection between CKD and cardiovascular disease, is involved in the development of cardiovascular complications in patients with CKD and is indicative of prognosis (Chan et al., Eur Heart J, 2021, 42(13), 1244–1253). Therefore, only by understanding the mechanisms underlying the sequential development of inflammation in CKD patients and breaking the vicious circle between inflammation-mediated renal and cardiac insufficiency is it possible to improve the prognosis of patients with end-stage renal disease (ESRD). This review highlights the mechanisms of inflammation and the oxidative stress that co-exists with inflammation in uremic patients on dialysis, as well as the mechanisms of cardiovascular complications in the inflammatory state, and provides clinical recommendations for the anti-inflammatory treatment of cardiovascular complications in such patients.
Highlights
Chronic kidney disease progressing to the uremic stage requires maintenance dialysis therapy to manage complications, prolong patient survival and improve quality of life
The Chronic kidney disease (CKD) environment accelerates the progression of central and peripheral arterial disease, especially the onset and progression of atherosclerosis (Johansen et al, 2021).In HD conditions, the microinflammatory state underlying chronic kidney disease can be exacerbated by abnormalities in the immune system, complement activation triggered by blood contact with the dialysis membrane, accumulation of urotoxins and endotoxin translocation, accumulation of inflammatory factors due to decreased renal filtration capacity and local injury due to arteriovenous fistula formation
Scavenges reactive oxygen species (ROS), reduces inflammatory response, plays a role in phagocytosis and reduces inflammation, and protects against hemodialysis, ischemia, and various renal diseases Reducing the production of acetyl coenzyme a and the production of free radicals reduces the production of proinflammatory factors in dialysis patients and is beneficial to the kidney In dialysis patients, oxidative stress is associated with reduced vitamin C (Mirna et al, 2020)
Summary
Chronic kidney disease (CKD) and cardiac insufficiency often co-exist, in uremic patients on hemodialysis (HD). The occurrence of abnormal renal function in patients with cardiac insufficiency is often indicative of a poor prognosis. Patients with chronic kidney disease, uremic patients on HD, often have cardiovascular complications in addition to abnormal endothelial function with volume overload, persistent inflammatory states, calcium overload, and imbalances in redox responses. Inflammation, as an important intersection between CKD and cardiovascular disease, is involved in the development of cardiovascular complications in patients with CKD and is indicative of prognosis (Chan et al, Eur Heart J, 2021, 42(13), 1244–1253). Only by understanding the mechanisms underlying the sequential development of inflammation in CKD patients and breaking the vicious circle between inflammation-mediated renal and cardiac insufficiency is it possible to improve the prognosis of patients with end-stage renal disease (ESRD).
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