Cardiovascular disease in chronic renal failure: the challenge continues

Despite many technical advances in medical care and dialysis, morbidity and mortality remain so high that the 5 year survival of patients aged > 64 years when starting dialysis is worse than that of patients affected by malignancies. The age-adjusted death rate of dialysis patients is estimated to be four to five times higher than that of the general population. Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in dialysis patients, accounting for about 50% of deaths [1–10] (Figure 1) and 30% of hospitalizations in most registries [11]. ... Cardiovascular deaths occurs among dialysis patients are approximately 30 times higher than in the general population [12], so chronic renal failure (CRF) has recently been defined as a ‘vasculopathic state’ [13]. The understanding and proper management of the determinants of cardiovascular disease have therefore become a major focus of nephrology care. There has been a striking increase in the incidence and prevalence of end-stage renal disease (ESRD) over the last 30 years. Data of the Registro Lombardo Dialisi e Trapianto (RLDT) indicate that at the end of 1997 the prevalence of ESRD was 889 per million population (p.m.p.) and the incidence was 123 p.m.p., both having increased by about 70% in the last decade. [1] An even more pronounced trend was observed in the USA, where the prevalence of ESRD more than doubled during 1988–1997, reaching 1105 p.m.p. in 1997 (there being 304 083 patients with ESRD at that time). Similarly, the incidence nearly doubled during that decade, reaching 287 p.m.p. in 1997 (79 102 incident cases) [11].