Nephrol Dial Transplant (2000) 15: 454-457
© 2000 European Renal Association-European Dialysis and Transplant Association
Editorial Comments
Cardiovascular risk in uraemic patients—is it fully explained by classical risk factors?
CNR Centre of Clinical Physiology, Reggio C, Italy
Correspondence and offprint requests to: Prof. Zoccali, Divisione di Nefrologia e Trapianto di Rene, Centro di Fisiologia Clinica del, Consiglio Nazionale delle Ricerche, Via Sbarre Inferiori 39, I-89100 Reggio Calabria, Italy.
What is a risk factor?
The definition of risk factor does not imply a causal association between the factor and the disease. A non-causal association between a risk factor and a disease may result when the factor in question is a marker for another causal factor (confounding) or when it reflects the disease itself (reverse causality). Many risk factors in dialysis patients are not causal, but reflect the severity of the uraemic syndrome. In itself, urea cannot be considered responsible for the high mortality seen in the dialysis population. However, the plasma concentration of this substance reflects the severity of the uraemic syndrome (disease marker), thus establishing a link between chronic uraemia and mortality. Non-causal risk factors are useful to stratify patients and identify high-risk groups, but the identification of causal factors is essential for planning interventions aimed at reducing total and cardiovascular mortality. The scientific strategy for the identification of causal factors is complex
The epidemic of cardiovascular disease in uraemic patients
Do classical cardiovascular risk factors explain the high mortality of dialysis patients?
Classical cardiovascular risk factors in uraemic patients
Hypertension
Cholesterol and lipoprotein (a)
Other risk factors and factors peculiar to chronic renal failure
Anaemia
Homocysteine
Hyperparathyroidism–hyperphosphataemia
Chronic inflammatory processes
References
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