Page 329 - Read Online

Page 2 of 10 Archakova et al. Vessel Plus 2018;2:34 I http://dx.doi.org/10.20517/2574-1209.2018.52

It is well known that patients with diabetes often have clinically proven ischemic heart disease (IHD) and
[3-5]
heart failure (HF) compared to a group of the same age without diabetes .

According to the American Heart Association, DN ranks second among the leading causes of death in
[6]
patients with type 2 diabetes . In the United States and Japan, DN is most common among all kidney
diseases (35%-45%), eclipsing such kidney pathologies as glomerulonephritis, polycystic kidney disease,
pyelonephritis, etc. In Europe, the prevalence of DN is less threatening, but the demand for extracorporeal
[7]
treatment continues to grow .

According to the National Kidney Foundation of Japan (1998) there is a high prevalence of cardiovascular
morbidity in patients with chronic kidney disease (CKD), and cardiovascular mortality is higher in dialysis
[8]
patients than in the general population .
Patients with CKD and diabetes are considered the highest risk group for the development of cardiovascular
[9]
complications , which require appropriate preventive measures. The complex clinical profile of patients
with diabetes on long-term hemodialysis (LTH) has prompted the search for new markers of cardiovascular
risk, determined the tactics of therapy and the importance of prevention measures for cardiovascular
complications. The purpose of the review is to analyze literature data on the evaluation of both traditional
and non-traditional risk factors for cardiovascular morbidity in patients with diabetes on LTH, in order to
find a more effective approach to therapeutic and diagnostic tactics.

ATHEROSCLEROSIS, KIDNEY DISEASE AND CARDIOVASCULAR DISEASES IN PATIENTS

WITH TYPE 2 DIABETES MELLITUS
Atherosclerosis is a multifaceted disease, with traditional risk factors such as diabetes, obesity, dyslipidemia
and hypertension, smoking and low physical activity.

[10]
Tanaka et al. showed that the low glomerular filtrate rate and proteinuria are independently associated
with the development of atherosclerosis, which is facilitated by various pathogenetic mechanisms. CKD is
a risk factor for the development of cardiovascular morbidity, and it also contributes to the development
of dyslipidemia. Depending on the stage of the process, the nature of dyslipidemia in patients with CKD
[11]
is different . In the initial stages of CKD hypertriglyceridemia (HTG) develops because the enzymatic
breakdown of triglycerides decreases due to a reduction in lipoprotein lipase activity.

CKD is also characterized by a decrease in the concentration of high-density anti-atherogenic lipoproteins
(HDL), due to a low concentration and a decrease in the activity of lecithin-cholesterol acyltransferase, which
leads to a disruption in the synthesis and transport of HDL and their accelerated degradation .
[12]
It was shown that in patients with significant proteinuria and nephrotic syndrome, lipid metabolism disorders are
[13]
[14]
associated with the increase of low-density lipoproteins (LDL), HTG and hypercholesterolemia . Kato et al.
showed that cardiovascular events are the main cause of death in patients on LTH. The index of intima-
media thickness (IMT) was significantly higher in patients who died from cardiovascular diseases and
correlated with age and calcification of the aorta, showing the importance of measuring the IMT index as a
predictor of the progression of cardiovascular mortality in patients on LTH.

[15]
Gluba et al. demonstrated that end-stage renal disease and type 2 diabetes are associated with the
accelerated development of atherosclerosis. It was shown that atherosclerosis in the carotid and coronary
[16]
arteries is an independent prognostic factor of mortality in patients with end-stage of CKD . In DN and
[17]
manifested atherosclerosis, altered LDL are detected, which undergo oxidative modification .