ESRD-induced dyslipidemia-Should management of lipid disorders differ in dialysis patients?
ESRD-induced dyslipidemia-Should management of lipid disorders differ in dialysis patients?
复制标题
DOI：
10.1111/sdi.12706
复制
发表时间：
2018-07
影响因子：
1.6
通讯作者：
Vaziri ND
中科院分区：
文献类型：
--
作者：
Moradi H;Streja E;Vaziri ND
心血管疾病是全世界发病率和死亡率的主要原因。尽管在心血管疾病的发病机制及其相关的死亡率中已经确定了许多可改变的危险因素，但血脂异常仍然是治疗的关键焦点。在这方面，通过使用降脂药如HMG CoA还原酶抑制剂（他汀类药物）在降低心血管死亡率方面取得了显著进展。然而，尽管晚期慢性和终末期肾病（ESRD）患者的心血管疾病和死亡风险不成比例，但在该患者人群中治疗血脂异常与结局的显著改善无关。此外，观察性研究并未一致发现血脂异常与ESRD患者不良结局之间的相关性。然而，必须在肾脏疾病特有的许多因素的背景下检查血脂异常及其与结局的相关性，这些因素可能导致ESRD患者的脂质代谢异常。了解这些复杂性和独特的特征不仅对解释有关结局的现有临床数据至关重要，而且对ESRD脂质治疗的个体化也至关重要。在这篇综述中，我们将研究血脂异常的性质和潜在机制，血脂和脂蛋白浓度与结局的相关性，以及针对ESRD患者胆固醇（主要是他汀类药物）的主要试验结果。
Cardiovascular disease is a major cause of morbidity and mortality worldwide. Although numerous modifiable risk factors in the pathogenesis of cardiovascular disease and its associated mortality have been identified, dyslipidemia remains to be a key focus for therapy. In this regard, significant progress has been made in reducing cardiovascular mortality via the use of lipid-lowering agents such as HMG CoA reductase inhibitors (statins). Yet, despite the disproportionate risk of cardiovascular disease and mortality in patients with advanced chronic and end stage renal disease (ESRD), treatment of dyslipidemia in this patient population has not been associated with a notable improvement in outcomes. Furthermore, observational studies have not consistently found an association between dyslipidemia and poor outcomes in patients with ESRD. However, it is imperative that examination of dyslipidemia and its association with outcomes take place in the context of the many factors that are unique to kidney disease and may contribute to the abnormalities in lipid metabolism in patients with ESRD. Understanding these intricacies and distinct features will be vital not only to the interpretation of the available clinical data in regards to outcomes, but also to the individualization of lipid therapy in ESRD. In this review, we will examine the nature and underlying mechanisms responsible for dyslipidemia, the association of serum lipids and lipoprotein concentrations with outcomes and the results of major trials targeting cholesterol (mainly statins) in patients with ESRD.
登录
查看更多内容
影响因子：
3.7
作者：
Honda H;Hirano T;Ueda M;Kojima S;Mashiba S;Hayase Y;Michihata T;Shishido K;Takahashi K;Hosaka N;Ikeda M;Sanada D;Shibata T
通讯作者：
Shibata T
影响因子：
168.9
作者：
Holdaas, H;Fellström, B;Pedersen, TR
通讯作者：
Pedersen, TR
影响因子：
13.6
作者：
Kopecky, Chantal;Ebtehaj, Sanam;Tietge, Uwe J. F.
通讯作者：
Tietge, Uwe J. F.
影响因子：
19.6
作者：
Frischmann, M. E.;Kronenberg, F.;Dieplinger, H.
通讯作者：
Dieplinger, H.
影响因子：
13.6
作者：
Kovesdy, Csaba P.;Anderson, John E.;Kalantar-Zadeh, Kamyar
通讯作者：
Kalantar-Zadeh, Kamyar