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      Emerging Biomarkers for Evaluating Cardiovascular Risk in the Chronic Kidney Disease Patient: How Do New Pieces Fit into the Uremic Puzzle?

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          Abstract

          Premature cardiovascular disease (CVD), including stroke, peripheral vascular disease, sudden death, coronary artery disease, and congestive heart failure, is a notorious problem in patients with chronic kidney disease (CKD). Because the presence of CVD is independently associated with kidney function decline, it appears that the relationship between CKD and CVD is reciprocal or bidirectional, and that it is this association that leads to the vicious circle contributing to premature death. As randomized, placebo-controlled trials have so far been disappointing and unable to show a survival benefit of various treatment strategies, such a lipid-lowering, increased dialysis dose and normalization of hemoglobin, the risk factor profile seems to be different in CKD compared with the general population. Indeed, seemingly paradoxical associations between traditional risk factors and cardiovascular outcome in patients with advanced CKD have complicated our efforts to identify the real cardiovascular culprits. This review focuses on the many new pieces that need to be fit into the complicated puzzle of uremic vascular disease, including persistent inflammation, endothelial dysfunction, oxidative stress, and vascular ossification. Each of these is not only highly prevalent in CKD but also more strongly linked to CVD in these patients than in the general population. However, a causal relationship between these new markers and CVD in CKD patients remains to be established. Finally, two novel disciplines, proteomics and epigenetics, will be discussed, because these tools may be helpful in the understanding of the discussed vascular risk factors.

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          Author and article information

          Journal
          Clin J Am Soc Nephrol
          Clin J Am Soc Nephrol
          clinjasn
          cjn
          CJASN
          Clinical Journal of the American Society of Nephrology : CJASN
          American Society of Nephrology
          1555-9041
          1555-905X
          March 2008
          01 March 2008
          : 3
          : 2
          : 505-521
          Affiliations
          [* ]Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; and
          []INSERM, ERI-12, Amiens, France, and Division(s) of Clinical Pharmacology and Nephrology, University of Picardie and Amiens University Hospital, Amiens, France
          Author notes
          Correspondence: Dr. Peter Stenvinkel, Department of Renal Medicine, K56, Karolinska University Hospital at Huddinge, 141 86 Stockholm, Sweden. Phone: +468-58582532; Fax: +46-8-7114742; E-mail: peter.stenvinkel@ 123456ki.se
          Article
          PMC6631093 PMC6631093 6631093 03670807
          10.2215/CJN.03670807
          6631093
          18184879
          1f0138d1-a8df-4a94-a966-980fca41e26d
          Copyright © 2008 by the American Society of Nephrology
          History
          Page count
          Figures: 4, Tables: 1, Equations: 0, References: 199, Pages: 0
          Categories
          In-Depth Reviews
          Custom metadata
          March 01, 2008
          v1

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