Published online before print January 9, 2006, doi: 10.1161/01.HYP.0000201235.90035.6c
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(Hypertension. 2006;47:141.)
© 2006 American Heart Association, Inc.
Editorial Commentaries |
Pressure, Waves, and Kidney Outcomes in Kidney Transplant Donors and Recipients
From the University of Texas Southwestern Medical Center Dallas.
Correspondence to Robert D. Toto, M.D., Professor of Medicine, University of Texas Southwestern Medical Center Dallas, 5323 Harry Hines Blvd, Dallas, Texas 75390. E-mail robert.toto@utsouthwestern.edu
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
Chronic kidney disease is a major public health problem in the United States.1 Recent observations indicate that nearly 20 million adult Americans have some degree of chronic kidney disease and that the majority are not those with end-stage disease but have various stages of milder degrees of kidney damage.2 However, for those with kidney disease not on dialysis (or transplanted), the risk for progression of kidney disease to end stage is markedly increased; moreover, these individuals are at very high risk for nonrenal cardiovascular events, such as myocardial infarction, stroke, heart failure, and sudden death. Several recent studies indicate that chronic kidney disease is an independent risk factor for cardiovascular morbidity and mortality, and this relationship is graded, continuous, and inversely related to the level of estimated glomerular filtration rate.3–5 Still, it is not yet known whether chronic kidney disease is simply a marker of underlying serious cardiovascular disease or whether the kidney disease itself contributes the risk, perhaps through accumulation of unwanted (detrimental) metabolites, the presence of a uremic milieu, or through known risk factors, such as hypertension. Both hypertension and diabetes are major risk factors for the development and progression of kidney disease; other factors related to cardiovascular health have also been implicated, including homocysteine, abnormal calcium phosphorus metabolism, chronic inflammation, anemia, and oxidative stress.6
Renal transplantation is currently the optimal treatment for end-stage kidney disease and is associated with improved quality of life, as well as survival advantage, as compared with any chronic dialysis modality.7 Living donor
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Hypertension 2006 47: 216-221.