Cardiovascular Morbidity in Hemodialysis: The Reverse Epidemiology Phenomenon

摘要: The Framingham study that begun more than 60 years ago (1948) has shaped the way Western societies face cardiovascular disease (CVD). relative impact of this (now on its 3rd generation participants) [1] been so impressive both public health authorities and medical community have fully endorsed results: since then, hypertension, dyslipidemia, tobacco smoking, diabetes mellitus recently obesity hypertriglyceridemia are considered as major risk factors for new morbidity overall mortality. Major advances aiming at prevention management had a significant survival patients with CVD. These advances, together extinction undernutrition after 2nd World War, led to an increase in thus number chronic states (congestive heart failure, kidney disease, dialysis patients, cancer etc) survive over prolonged time periods. Numerous epidemiological studies last decade, observed these subgroups well established-for general populationsurrogates metabolic syndrome obesity, hypercholesterolemia hypertension paradoxically associated greater survival. Hence term “reverse epidemiology paradox” was coined literature. Approximately 9% US adult population (about 20 million people) d stage 1 (CKD-1) 2% receiving maintenance dialysis. It projected will exceed by 2018. should be emphasized although CKD-5 is expected life-prolonging, 5-year only about 35% [2,3]. Robust observational repeatedly shown even adjustments comorbidities, moderately higher levels blood pressure, body mass index (BMI) cholesterol improved This chapter review data concerning role arterial mortality hemodialysis (HD) discuss potential pathogenetic mechanisms could possibly explain called paradox”.