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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Despite the improvements in dialysis technology, the cardiovascular mortality rate is still unacceptably high among dialysis patients. It is obvious that traditional risk factors, such as hypertension, chronic heart failure (CHF), dyslipidemia and diabetes mellitus, may account for a large part of the increased cardiovascular mortality rate in these patients. However, based on recent research it could be speculated that other, non-traditional risk factors might also contribute to the high cardiovascular mortality rate in dialysis patients. Chronic inflammation, as evidenced by increased levels of pro-inflammatory cytokines and C-reactive protein (CRP), is a common feature in dialysis patients and is associated with an increased cardiovascular morbidity and mortality. Indeed, elevated levels of pro-inflammatory cytokines (such as TNF-alpha, IL-1 and IL-6) may cause malnutrition and progressive atherosclerotic cardiovascular disease by several pathogenetic mechanisms, which will be discussed in this review. Based on the strong associations observed between malnutrition, inflammation and atherosclerosis in patients with chronic renal failure (CRF) we have proposed that these features constitute a specific syndrome (MIA), which carries a high mortality rate. As elevated levels of pro-inflammatory cytokines may play a central part in the vicious circle of malnutrition, inflammation and atherosclerosis, further research is needed to investigate whether or not different anti-cytokine treatment strategies may improve survival in dialysis patients.
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PMID:Inflammatory and atherosclerotic interactions in the depleted uremic patient. 1111 78

Cardiovascular disease (CVD) remains the main cause of morbidity and mortality in patients with end-stage renal disease (ESRD). Although traditional risk factors are common in ESRD patients, they alone may not be sufficient to account for the high prevalence of CVD in this condition. Recent evidence demonstrates that chronic inflammation, a nontraditional risk factor which is commonly observed in ESRD patients, may cause malnutrition and progressive atherosclerotic CVD by several pathogenetic mechanisms. The causes of inflammation in ESRD are multifactorial and, while it may reflect underlying CVD, an acute-phase reaction may also be a direct cause of vascular injury by several pathogenetic mechanisms. Available data suggest that proinflammatory cytokines play a central role in the genesis of both malnutrition and CVD in ESRD. Thus it could be speculated that suppression of the vicious cycle of malnutrition, inflammation, and atherosclerosis (MIA syndrome) would improve survival in dialysis patients. Recent evidence has demonstrated strong associations between inflammation and both increased oxidative stress and endothelial dysfunction in ESRD patients. As there is not yet any recognized, or even proposed, treatment for ESRD patients with chronic inflammation, it would be of obvious interest to study the long-term effect of various anti-inflammatory treatment strategies on the nutritional and cardiovascular status as well as outcome in these patients.
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PMID:Inflammation in end-stage renal disease: sources, consequences, and therapy. 1235 37

Inflammatory markers such as C-reactive protein are frequently elevated in patients treated by dialysis. Serum concentration of these markers are much higher than in the general population, in which it has been clearly shown that chronic inflammation is associated to the occurrence of cardiovascular events. The mechanisms leading to chronic inflammation in dialysis patients may be related to chronic inflammation per se, or to dialysis. Furthermore, in these patients, raised inflammatory markers are associated to malnutrition and increased cardiovascular morbidity and mortality. The association of inflammation, malnutrition and atherosclerosis defines the so-called MIA syndrome.
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PMID:[Inflammatory markers in dialysis: epidemiological data]. 1465 Jul 44

Cardiovascular disease (CVD) remains the main cause of morbidity and mortality in patients with end-stage renal disease (ESRD). Traditional risk factors are common in ESRD patients, but they alone may not be sufficient to account for the high prevalence of CVD in this population. Recent clinical evidence demonstrates that chronic inflammation, a non traditional risk factor which is commonly observed in ESRD patients, may be associated with the presence of poor nutritional parameters and progressive atherosclerotic CVD. Based on these observations, the presence in ESRD patients of a syndrome consisting in malnutrition, signs of systemic chronic inflammation and atherosclerosis (MIA syndrome) has recently been suggested. A central role in this syndrome is played by the proinflammatory cytokines generated in response to factors such as chronic renal failure and infectious-inflammatory co-morbid disease. It is now clear that the immune response, both innate and adaptive, is the main cause of inflammation characterising atherosclerosis. As there is as yet no recognized, or even proposed, treatment for ESRD patients with chronic inflammation, it would be of obvious interest to study the long-term effect of various inflammatory treatment strategies on the nutritional and cardiovascular status as well as the outcome in these patients.
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PMID:[Chronic inflammation and cardiovascular risk in hemodialysis]. 1473 17

Despite rapid improvements in dialysis technology during the last 20 years, the mortality rate in end-stage renal disease (ESRD) patients treated with dialysis is still unacceptably high and comparable to that of many cancer patients with metastases. The main cause of the increased mortality in ESRD patients is cardiovascular disease (CVD), which is twice as common and advances at twice the rate already in patients with earlier stages of chronic kidney disease as compared to the general population. Although traditional risk factors are common in dialysis patients, they can only in part explain the very high prevalence of CVD in this patient group. Recent evidence demonstrates that chronic inflammation, a non-traditional risk factor which is a commonly observed in dialysis patients, may cause malnutrition and progressive atherosclerotic CVD by several pathogenetic mechanisms. Available data suggest that pro-inflammatory cytokines play a central role in the genesis of both malnutrition and CVD in ESRD. While the long-term effects of chronic inflammation may be most important in the pathogenesis of CVD, the acute-phase reaction may also be a direct cause of acute vascular injury by several pathogenetic mechanisms. The cause(s) of inflammation in dialysis are multifactorial and include both dialysis-related and unrelated factors. Thus, it could be speculated that suppression of the vicious cycle of malnutrition, inflammation, and atherosclerosis (MIA syndrome) would improve survival in dialysis patients. As there are currently no established guidelines for the treatment of chronic inflammation in ESRD patients, studies on the long-term effects of various anti-inflammatory treatment strategies on the nutritional and cardiovascular status as well as outcome in this patient group are warranted.
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PMID:Systemic inflammation in dialysis patients with end-stage renal disease: causes and consequences. 1546 2

Despite marked improvements in dialysis technology during the last 20 years, the age-adjusted mortality rate in end-stage renal disease (ESRD) patients treated by dialysis is still unacceptably high and comparable to that of many cancer patients with metastases. The main cause of the increased mortality in ESRD patients is cardiovascular disease (CVD), which is twice as common and advances at twice the rate already in patients with early stages of chronic kidney disease as compared to the general population. Although traditional risk factors for CVD are common in dialysis patients, they can only in part explain the very high prevalence of CVD in this patient group. Recent evidence demonstrates that chronic inflammation, a non-traditional risk factor which is a commonly observed in dialysis patients, may cause progressive atherosclerotic CVD and malnutrition, itself an important risk factor for the development of CVD, by several pathogenetic mechanisms. The causes of inflammation in dialysis are multifactorial and include both dialysis-related and unrelated factors. While the long-term effects of chronic inflammation may be most important in the pathogenesis of CVD, the acute-phase reaction may also cause vascular damage by several pathogenic mechanisms. Indeed, it seems logical to speculate that suppression of the vicious cycle of malnutrition, inflammation, and atherosclerosis (MIA syndrome) in ESRD would improve survival and decrease co-morbidity in dialysis patients. As there are currently no established guidelines for the treatment of chronic inflammation in ESRD patients, more studies on the long-term effects of various anti-inflammatory treatment strategies on the nutritional and cardiovascular status, as well as outcome in this patient group, are clearly warranted and will be helpful in identifying precisely which pathways are most involved in the pathogenic process.
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PMID:Chronic systemic inflammation in dialysis patients: an update on causes and consequences. 1567 81

Cardiovascular disease (CVD) remains the main cause of morbidity and mortality in patients with end-stage renal disease (ESRD). Although traditional risk factors, such as diabetes mellitus, hypertension, dyslipidemia and advanced age, are prevalent in ESRD patients they may not be sufficient by themselves to account for the high prevalence of CVD in patients with this condition. Thus, the search for other, non-traditional, risk factors that may be involved in the pathogenesis of uremic CVD has been an area of intense study. Data suggest that the accelerated atherosclerotic process of ESRD may involve several interrelated processes, such as oxidative stress, endothelial dysfunction and vascular calcification, in a milieu of constant low-grade inflammation. The cause(s) of inflammation in ESRD are multifactorial and, while it may reflect underlying CVD, an acute-phase reaction may also be a direct cause of vascular injury via several pathogenetic mechanisms. Available data suggest that pro-inflammatory cytokines play a central role in the genesis of both malnutrition and CVD in ESRD. Thus, it could be speculated that suppression of the vicious cycle of malnutrition, inflammation and atherosclerosis (MIA syndrome) would improve survival in dialysis patients. Recent evidence has demonstrated strong associations between inflammation and both increased oxidative stress and endothelial dysfunction in ESRD patients. As there is not yet any recognized, or even proposed, treatment for ESRD patients with chronic inflammation it would be of obvious interest to study the long-term effect of various anti-inflammatory treatment strategies on the nutritional and cardiovascular status as well as outcome of these patients.
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PMID:Traditional and non-traditional risk factors as contributors to atherosclerotic cardiovascular disease in end-stage renal disease. 1576 53

During hemodiafiltration (HDF) the increase in the ultrafiltration (uf) rate improves solute convective clearance. Therefore, considerable amounts of reinfusion liquid are necessary, whose quality must be guaranteed. The use of bags or bottles manufactured by industry causes many problems concerning handling (storage, repeated connections) and costs, and last but not least, it exposes the circuits to a contamination risk. Therefore, the technological research into on-line production systems of sterile and ultrapure reinfusion solutions is justified. The increasing interest in the on-line production of reinfusion fluids from the dialysing solution dates back to the 1990s, and the data in the literature are statistically positive concerning the improvement in depurative performances connected to the uf increase. Although, to be objective, a problem still exists, in real-time the absolute guarantee of the sterility and apirogenicity of the solutions produced on-line is impossible. Using a two-chamber filter, it is possible to produce reinfusion fluid from the uf of the patient himself, which has been 'regenerated' by a sorbent bed, in a closed circuit. This action eliminates any sterility problems, whilst, in addition, providing the possibility for good substance reinfusion such bicarbonates and essential and branched-chain aminoacids. This HDF method, hemo-filtrate-reinfusion (HFR), has clinically demonstrated, beyond its ease of execution, a reduction in physiological component loss, a high biocompatibility and an overall action in contrast to MIA syndrome factors, i.e. malnutrition, inflammation and atherosclerosis.
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PMID:[Hemodiafiltration with endogenous reinfusion (HFR): evolution of the method]. 1578 81

Malnutrition and chronic inflammation are frequently-occurring complications in dialysis patients. These conditions are associated with cardiovascular diseases and predict hospitalisation and mortality. There is assumed to be a pathophysiologic association between malnutrition, inflammation and atherosclerosis in this patient population. Indeed, chronic inflammation can induce an atherogenic and catabolic state, while a low food intake can lead to malnutrition and inflammation, but can also result from it. These complex associations constitute the basis for 'malnutrition, inflammation and atherosclerosis (MIA syndrome)'. Inflammation and malnutrition associated atherosclerosis may explain a large part of the high mortality in dialysis patients. An integrated approach is needed to treat this multifactorial complication. Randomised clinical trials on this subject are lacking as yet.
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PMID:[Malnutrition, inflammation and atherosclerosis (MIA-syndrome) in dialysis patients]. 1705 58

Protein-energy malnutrition with muscle wasting occurs in a large proportion of patients with chronic renal failure and is, in addition to atherosclerosis, a strong risk factor for cardiovascular mortality in dialysis patients. There is evidence that a chronic inflammation with activation of C-reactive protein and proinfalammatory cytokines is associated with increased oxidative stress and endothelial dysfunction. Strong relations between malnutrition, inflammation and atherosclerosis in dialysis patients suggest the presence of a MIA (malnutrition, inflammation and atherosclerosis) syndrome, which is associated with high mortality rate. Thus, it could be speculated that suppression of the vicious cycle of malnutrition, inflammation and atherosclerosis would improve survival in dialysis patients.
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PMID:Malnutrition, inflammation, atherosclerosis in hemodialysis patients. 1771 Oct 95


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