[Prevention of cardiovascular comorbidities in uremic patients on chronic dialysis: metabolic derangements and cardiovascular risk].

Cardiovascular events are the main cause of morbidity and mortality in uremic patients on renal replacement therapy. Traditional cardiovascular risk factors such as dyslipidemia and hypertension as well as risk factors specific to uremia such as calcium and phosphate metabolism derangements are involved in the development and progression of the cardiovascular alterations. In this review the results of prospective randomized trials that evaluated the effects on cardiovascular morbidity and mortality of lowering serum cholesterol and phosphate levels and controlling secondary hyperparathyroidism are critically reexamined. A recent trial of 9270 patients with chronic kidney disease documented a significant reduction of major atherosclerotic events by lowering LDL cholesterol by 39 mg/dL on average with sinvastatin plus ezetimibe over nearly 5 years. No significant reduction in mortality rate was documented by lowering serum phosphate levels with sevelamer rather than calcium-containing phosphate binders. Treatment of secondary hyperparathyroidism with cinacalcet plus lowdose vitamin D seems to attenuate the progression of vascular calcification.