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ABSTRACT The prevalence of cardiovascular morbidity and mortality is higher in patients with chronic kidney disease (CKD)—especially those with end-stage renal disease—than in the general

population. The contribution of atherosclerosis to cardiovascular disease in patients with CKD remains unclear. Researchers in the 1970s proposed that atherosclerosis was the main cause of

cardiovascular disease in patients with CKD and that its progression, based on observations of patients on long-term dialysis, was accelerated by the uremic state. Subsequent reports,

however, favor the involvement of other mechanisms, such as arteriosclerosis (characterized by vascular stiffening), vascular calcification, 'myocyte/capillary mismatch',

congestive cardiomyopathy, and sudden cardiac death. Imaging and morphological studies have contributed to our understanding of the pathogenesis and progression of cardiovascular disease

associated with CKD. Based on clinical and experimental findings, we hypothesize the following: the initial cardiovascular abnormalities in the CKD setting include arteriosclerosis, left

ventricular diastolic dysfunction, and left ventricular hypertrophy, abnormalities which, in adult patients, are often accompanied by atherosclerosis. The prevalence of atherosclerosis

increases with age and is aggravated, but not specifically induced, by CKD. The cardiovascular events associated with atherosclerosis are more often fatal in patients with CKD than in

individuals without CKD. KEY POINTS * The first cardiovascular changes observed in patients with chronic kidney disease (CKD) are arteriosclerosis (characterized by arterial stiffening and

loss of cushioning function), altered left ventricular diastolic function and left ventricular hypertrophy * Atherosclerosis (characterized by intimal thickening and loss of conduit

function) often occurs in parallel with initial cardiovascular changes (especially in elderly patients with CKD) and is probably not induced, but is aggravated by CKD * The severity of

atherosclerosis in patients with CKD could be affected by changes in plaque composition (that is, by qualitative differences) rather than by atheromatous plaque number or volume * Intimal

calcification is high in patients with CKD; although medial calcification is associated with arteriosclerosis, it is probably a secondary event in the late stages of CKD * The role of

uremia-specific factors in cardiovascular disease, as opposed to the classical risk factors (age, hypertension, diabetes, and smoking) requires further investigation * Atherosclerosis

clearly contributes to the high cardiovascular mortality rate of patients with CKD but is probably not one of the main causes of death Access through your institution Buy or subscribe This

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AND CARDIOMYOPATHY ASSOCIATED WITH CHRONIC KIDNEY DISEASE: EPIDEMIOLOGY, PATHOGENESIS AND TREATMENT CONSIDERATIONS Article Open access 22 September 2022 EPIDEMIOLOGY AND RISK OF

CARDIOVASCULAR DISEASE IN POPULATIONS WITH CHRONIC KIDNEY DISEASE Article 14 September 2022 DIAGNOSIS OF CARDIOVASCULAR DISEASE IN PATIENTS WITH CHRONIC KIDNEY DISEASE Article 23 August 2023

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Rostand, from the University of Alabama at Birmingham, AL, USA, for helpful discussion and suggestions for this manuscript. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Inserm ERI-12, UFR

de Médecine et de Pharmacie, Université de Picardie Jules Verne, 1 Rue des Louvels, 80037, Amiens, France Tilman B. Drüeke & Ziad A. Massy Authors * Tilman B. Drüeke View author

publications You can also search for this author inPubMed Google Scholar * Ziad A. Massy View author publications You can also search for this author inPubMed Google Scholar CONTRIBUTIONS T.

B. Drüeke and Z. A. Massy contributed equally to researching data for the article, substantial discussion of the content of the article and reviewing/editing the manuscript before

submission. T. B. Drüeke wrote the initial draft of the article. CORRESPONDING AUTHOR Correspondence to Tilman B. Drüeke. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no

competing financial interests. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Drüeke, T., Massy, Z. Atherosclerosis in CKD: differences from the general

population. _Nat Rev Nephrol_ 6, 723–735 (2010). https://doi.org/10.1038/nrneph.2010.143 Download citation * Published: 26 October 2010 * Issue Date: December 2010 * DOI:

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