The role of aldosterone blockade in end-stage renal disease.

摘要

Patients with end-stage renal disease (ESRD) undergoing dialysis are at high risk of cardiovascular disease including progressive heart failure (HF) and sudden cardiac death (SCD). These patients not only have an increase in cardiovascular risk factors such as hypertension, insulin resistance, the metabolic syndrome, diabetes mellitus, myocardial fibrosis, left ventricular hypertrophy, sleep apnea, and coronary artery disease, but also an ill-defined 'uremic cardiomyopathy' [1]. Severalpatho-physiologic processes have been implicated in the increased cardiovascular risk in these patients including an increase in oxidative stress, a decrease in nitric oxide availability, a decrease in endothelial function, an increase in autonomic dysfunction with an increase in sympathetic drive and a decrease in catecholamine ca-tabolism, an increase in Ca~(2+) and ion channel expression, changes in myocardial metabolism including a deregulation in fatty acid metabolism, especially in those with concomitant diabetes mellitus, endothelial dysfunction, a decrease in coronary flow reserve, vascular inflammation and calcification with a decrease in vascular compliance, as well as neurohumeral deregulation [2-6].