Elsevier

Kidney International

Volume 59, Issue 2, February 2001, Pages 407-414
Kidney International

Perspectives in Renal Medicine
End-stage renal disease, atherosclerosis, and cardiovascular mortality: Is C-reactive protein the missing link?

https://doi.org/10.1046/j.1523-1755.2001.059002407.xGet rights and content
Under an Elsevier user license
open archive

End-stage renal disease, atherosclerosis, and cardiovascular mortality: Is C-reactive protein the missing link? In uremic patients, the morbidity and mortality of cardiovascular disease are substantially higher than in the general population. This has led to the formulation of an “accelerated atherogenesis” hypothesis in uremic patients and has been commonly linked with the metabolic alterations associated with uremia. Advancement in the understanding of the pathogenesis of atherosclerotic vascular disease now suggests a central contribution of inflammation to atherogenesis, with involvement of a number of key mediators and markers of the inflammatory process. Recent epidemiological data have documented associations between C-reactive protein (CRP), the prototypical acute phase response protein, and cardiovascular disease in general population. Given the lipoprotein binding and complement activation functions of CRP and its localization in atherosclerotic vessels, there is a strong likelihood that CRP may be involved in the atherosclerotic process. The uremic state is associated with an altered immune response, which is associated with elevated proinflammatory cytokine levels. CRP concentrations are increased in a significant proportion of end-stage renal disease patients and have been associated with certain clinical outcome measures, including all-cause and cardiovascular mortality. This review outlines the evidence linking CRP with atherosclerosis and proposes that elevated CRP concentrations may be involved in the initiation and progression of accelerated atherosclerosis in uremia.

Keywords

uremia
dialysis
immune response
inflammatory disease
fatty streak lesion
fibrous plaque
vascular disease
acute phase response

Cited by (0)