Palabras clave
Cómo citar
Resumen
Los factores de riesgo cardiovascular (FRCV) como hipertensión arterial (HTA), diabetes mellitus tipo 2 (DM2) y dislipidemia suelen estar involucrados con la enfermedad renal crónica (ERC) y su contribución a la morbilidad cardiovascular. La disfunción endotelial difusa y la aterosclerosis están conceptualizadas como parte de la fisiopatología de la ERC en diabéticos y no diabéticos, particularmente en ancianos. La edad es el principal determinante de la tasa de filtración glomerular (TFG) y flujo plasmático renal efectivo y se ha reportado que la presencia de HTA favorece la declinación en la depuración de creatinina. La dislipidemia puede afectar directamente el riñón causando trastorno renal lipídico (lipotoxicidad renal) e indirectamente a través de la inflamación sistémica y estrés oxidativo, agresión vascular y cambios humorales y de otras moléculas de señalización con acción renal. Varios estudios transversales han encontrado que el deterioro a la tolerancia glucosada y la presencia de hipertrofia ventricular izquierda están asociados con un aumento en la pendiente de la relación inversa entre edad y TFG en sujetos con HTA no tratada. La mayoría de las drogas empleadas para reducir la carga de los FRCV también son beneficiosas para la función renal. De tal forma que se propone al continuo cardiorrenal como una estrategia preventiva para proteger ambos órganos y reducir el impacto deletéreo de los FRCV sobre la función renal partiendo del punto de vista de un binomio funcional y fisiopatológico.
Citas
Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment. Lancet Diabetes Endocrinol. 2014;2(8):634-47. Available from: https://doi.org/10.1016/S2213-8587(14)70102-0
Amsalem Y, Garty M, Schwartz R, Sandach A, Behar S, Caspi A, et al. Prevalence and significance of unrecognized renal insufficiency in patients with heart failure. Eur Heart J. 2008;29(8):1029-36. Available from:
https://doi.org/10.1093/eurheartj/ehn102
Ronco C, House AA, Haapio M. Cardiorenal syndrome: refining the definition of a complex symbiosis gone wrong. Intensive Care Med. 2008;34(5):957-62. Available from: https://doi.org/10.1007/s00134-008-1017-8
Arocha JI, Amair P. El eje cardiorrenal: una nueva estrategia con trascendencia clínica. Av. Cardiol. 2010;30(4):382-7.
Guyton AC. The surprising kidney-fluid mechanism for pressure control-its infinite gain! Hypertension. 1990;16(6):725-30. Available from: https://doi.org/10.1161/01.hyp.16.6.725
Stevenson LW, Nohria A, Mielniczuk L. Torrent or torment from the tubules? Challenge of the cardiorenal connections. J Am Coll Cardiol. 2005;45(12):2004-7. Available from: https://doi.org/10.1016/j.jacc.2005.03.028
Bakris G, Vassalotti J, Ritz E, Wanner C, Stergiou G, Molitch M, et al. National Kidney Foundation consensus conference on cardiovascular and kidney diseases and diabetes risk: an integrated therapeutic approach to reduce events. Kidney Int. 2010;78(8):726-36. Available from: https://doi.org/10.1038/ki.2010.292
Gracia M, Betriu À, Martínez-Alonso M, Arroyo D, Abajo M, Fernández E, et al. Predictors of Subclinical Atheromatosis Progression over 2 Years in Patients with Different Stages of CKD. Clin J Am Soc Nephrol. 2016;11(2):287-96. Available from: https://doi.org/10.2215/CJN.01240215
Hsu S, Rifkin DE, Criqui MH, Suder NC, Garimella P, Ginsberg C, et al. Relationship of femoral artery ultrasound measures of atherosclerosis with chronic kidney disease. J Vasc Surg. 2018;67(6):1855-63.e1. Available from:
https://doi.org/10.1016/j.jvs.2017.09.048
Kastarinen H, Ukkola O, Kesäniemi YA. Glomerular filtration rate is related to carotid intima-media thickness in middle-aged adults. Nephrol Dial Transplant. 2009;24(9):2767-72. Available from: https://doi.org/10.1093/ndt/gfp172.
Buscemi S, Geraci G, Massenti FM, Buscemi C, Costa F, D’Orio C, et al. Renal function and carotid atherosclerosis in adults with no known kidney disease. Nutr Metab Cardiovasc Dis. 2017;27(3):267-73. Available from: https://doi.org/10.1016/j.numecd.2016.09.013
Botdorf J, Chaudhary K, Whaley-Connell A. Hypertension in Cardiovascular and Kidney Disease. Cardiorenal Med. 2011;1(3):183-92. Available from: https://doi.org/10.1159/000329927
Doshi SM, Friedman AN. Diagnosis and Management of Type 2 Diabetic Kidney Disease. Clin J Am Soc Nephrol. 2017;12(8):1366-73. Available from: https://doi.org/10.2215/ CJN.11111016
Bulbul MC, Dagel T, Afsar B, Ulusu NN, Kuwabara M, Covic A, et al. Disorders of Lipid Metabolism in Chronic Kidney Disease. Blood Purif. 2018;46(2):144-52. Available from: https://doi.org/10.1159/000488816
Orth SR. Effects of Smoking on Systemic and Intrarenal Hemodynamics: Influence on Renal Function. J Am Soc Nephrol. 2004;15(Suppl 1):S58-63. Available from: https://doi.org/10.1097/01.asn.0000093461.36097.d5
Bramlage P, Lanzinger S, van Mark G, Hess E, Fahrner S, Heyer CHJ, et al. Patient and disease characteristics of type-2 diabe- tes patients with or without chronic kidney disease: an analysis of the German DPV and DIVE databases. Cardiovasc Diabetol. 2019;18(1):33. Available from: https://doi.org/10.1186/s12933-019-0837-x
Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA AAPA/ABC/ ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):1269-324. Available from: https://doi.org/10.1161/ HYP.0000000000000066
William B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-104. Available from: https://doi.org/10.1093/eurheartj/ehy339
Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015; 373(22):2103-16. Available from: https://doi.org/10.1056/ NEJMoa1511939.
Bragg F, Li L, Bennett D, Guo Y, Lewington S, Bian Z, et al. Association of Random Plasma Glucose Levels With the Risk for Cardiovascular Disease Among Chinese Adults Without Known Diabetes. JAMA Cardiol. 2016;1(7):813-23. Available from: https://doi.org/10.1001/jamacardio.2016.1702.
American Diabetes Association. 11. Microvascular compli- cations and foot care: Standards of Medical Care in Diabetes 2019. Diabetes Care. 2019;42(Suppl 1):S124-38. Available from: https://doi.org/10.2337/dc19S010
Bancks MP, Ning H, Allen NB, Bertoni AG, Carnethon MR, Correa A, et al. Long-Term Absolute Risk for Cardiovascular Disease Stratified by Fasting Glucose Level. Diabetes Care. 2019;42(3):457-65. Available from: https://doi.org/10.2337/dc18-1773
Pascual V, Serrano A, Pedro-Botet J, Ascaso J, Barrios V, Millán J, et al. Enfermedad renal crónica y dislipidemia. Clin Investig Arterioscler. 2017;29(1):22-35. Available from: https://doi.org/10.1016/j.arteri.2016.07.004
Wanner C, Tonelli M; Kidney Disease: Improving Global Outcomes Lipid Guideline Development Work Group Members. KDIGO Clinical Practice Guideline for Lipid Management in CKD: summary of recommendation statements and clinical approach to the patient. Kidney Int. 2014;85(6):1303-9. Available from: https://doi.org/10.1038/ki.2014.31.
Waters DD. LDL-cholesterol lowering and renal outcomes. Curr Opin Lipidol. 2015;26(3):195-9. Available from:
https://doi.org/10.1097/MOL.0000000000000176.
McMahon GM, Preis SR, Hwang SJ, Fox CS. Mid-adulthood risk factor profiles for CKD. J Am Soc Nephrol. 2014;25(11): 2633-41. Available from: https://doi.org/10.1681/ASN.2013070750.
Chang AR, Grams ME, Ballew SH, Bilo H, Correa A, Evans M. et al. Adiposity and risk of decline in glomerular filtration rate: meta-analysis of individual participant data in a global consortium. BMJ. 2019;364:k5301. Available from: https://doi.org/10.1136/bmj.k5301
Sikorska D, Grzymislawska M, Roszak M, Gulbicka P, Korybalska K, Witowski J. Simple obesity and renal function. J Physiol Pharmacol. 2017;68(2):175-80.
Escasany E, Izquierdo-Lahuerta A, Medina-Gomez G. Underlying Mechanisms of Renal Lipotoxicity in Obesity. Nephron. 2019;143(1):28-32. Available from: https://doi.org/10.1159/000494694
Kovesdy CP, Furth S, Zoccali C; en nombre del Comité Directivo del Día Mundial del Riñón. Electronic address: myriam@ worldkidneyday.org. Obesidad y enfermedad renal: consecuencias ocultas de la epidemia. Nefrologia. 2017;37(4): 360-9. Available from: https://doi.org/10.1016/j.nefro.2017. 02.005.
Nam KH, Yun HR, Joo YS, Kim J, Lee S, Lee C, et al. Changes in obese metabolic phenotypes over time and risk of incident chronic kidney disease. Diabetes Obes Metab. 2018;20(12): 2778-91. Available from: https://doi.org/10.1111/dom.13458
Chang AR, Surapaneni A, Kirchner HL, Young A, Kramer HJ, Carey DJ, et al. Metabolically Healthy Obesity and Risk of Kidney Function Decline. Obesity (Silver Spring). 2018;26(4): 762-8. Available from: https://doi.org/10.1002/oby.22134.
Kuller LH, Ockene JK, Meilahn E, Wentworth DN, Svendsen KH, Neaton JD. Cigarette smoking and mortality. MRFIT Research Group. Prev Med. 1991;20(5):638-54. Available from: https://doi.org/10.1016/0091-7435(91)90060-h.
Rezonzew G, Chumley P, Feng W, Hua P, Siegal GP, Jaimes EA. Nicotine exposure and the progression of chronic kidney disease: role of the α7-nicotinic acetylcholine receptor. Am J Physiol Renal Physiol. 2012;303(2):F304-12. Available from: https://doi.org/10.1152/ajprenal.00661.2011
Lan X, Lederman R, Eng JM, Shoshtari SS, Saleem MA, Malhotra A, et al. Nicotine Induces Podocyte Apoptosis through Increasing Oxidative Stress. PLoS One. 2016;11(12):e0167071. Available from: https://doi.org/10.1371/journal.pone.0167071.
Kim CS, Choi JS, Joo SY, Bae EH, Ma SK, Lee J, et al. Nicotine- Induced Apoptosis in Human Renal Proximal Tubular Epithelial Cells. PLoS One. 2016;11(3):e0152591. Available from: https://doi.org/10.1371/journal.pone.0152591
Jaimes EA, Tian RX, Raij L. Nicotine: the link between cigarette smoking and the progression of renal injury? Am J Physiol Heart Circ Physiol. 2007;292(1):H76-82. Available from: https://doi.org/10.1152/ajpheart.00693.2006
López-Jaramillo P, Sánchez RA, Diaz M, Cobos L, Bryce A, Parra Carrillo JZ, et al. Latin American consensus on hypertension in patients with diabetes type 2 and metabolic syndrome. J Hypertens. 2013;31(2):223-38. Available from: https://doi.org/10.1097/HJH.0b013e32835c5444
Jha V, García-García G, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: global dimension and perspectives. Lancet. 2013;382(9888):260-72. Available from: https://doi.org/10.1016/S0140-6736(13)60687-X
Ruilope LM, Salvetti A, Jamerson K, Hansson L, Warnold I, Wedel H, et al. Renal function and intensive lowering of blood pressure in hypertensive participants of the hypertension optimal treatment (HOT) study. J Am Soc Nephrol. 2001;12(2):218-25.
Mann JF, Gerstein HC, Yi QL, Franke J, Lonn EM, Hoogwerf BJ, et al. Progression of renal insufficiency in type 2 diabetes with and without microalbuminuria: results of the Heart Outcomes and Prevention Evaluation (HOPE) randomized study. Am J Kidney Dis. 2003;42(5):936-42. Available from: https://doi.org/10.1016/j.ajkd.2003.07.015
Matsushita K, Ballew SH, Coresh J. Cardiovascular risk prediction in people with chronic kidney disease. Curr Opin Nephrol Hypertens. 2016;25(6):518-23. Available from: https://doi.org/10.1097/MNH.0000000000000265
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Eng J Med. 2004;351(13):1296-305. Available from: https://doi.org/10.1056/NEJMoa041031.
Keith DS, Nichols GA, Gullion CM, Brown JB, Smith DH. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med. 2004;164(6):659-63. Available from: https://doi.org/10.1001/archinte.164.6.659.
Cerasola G, Mulè G, Nardi E, Cusimano P, Palermo A, Arsena R, et al. Clinical correlates of renal dysfunction in hypertensive patients without cardiovascular complications: the REDHY study. J Hum Hypertens. 2010;24(1):44-50. Available from: https://doi.org/10.1038/jhh.2009.41
Hemmelgarn BR, Manns BJ, Lloyd A, James MT, Klarenbach S, Quinn RR, et al. Relation between kidney function, proteinuria, and adverse outcomes. JAMA. 2010;303(5):423-9. Available from: https://doi.org/10.1001/jama.2010.39.
Sabio R, Valdez P, Turbay YA, Andrade-Belgeri RE, Oze-de Morvil GAA, Arias C, et al. Recomendaciones latinoamerica- nas para el manejo de la hipertensión arterial en adultos (RELAHTA 2). Rev virtual Soc Parag Med Int. 2019;6(1):86-123. Available from: https://doi.org/10.18004/rvspmi/2312-3893/2019.06(01)86-123.
Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. Guía ESC 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica. Rev Esp Cardiol. 2016;69(10):939.e1-e87. Available from: https://doi.org/10.1016/j.recesp.2016.09.004
Major RW, Cheung CK, Gray LJ, Brunskill NJ. Statins and Cardiovascular Primary Prevention in CKD: A Meta-Analysis. Clin J Am Soc Nephrol. 2015;10(5):732-9. Available from: https://doi.org/10.2215/CJN.07460714.
Xie X, Atkins E, Lv J, Bennett A, Neal B, Ninomiya T, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta- analysis. Lancet. 2016;387(10017):435-43. Available from: https://doi.org/10.1016/S0140-6736(15)00805-3.
Muskiet MHA, Tonneijck L, Smits MM, Kramer MH, Heerspink HJ, van Raalte DH. Pleiotropic effects of type 2 diabetes management strategies on renal risk factors. Lancet Diabetes Endocrinol. 2015;3(5):367-81. Available from: https://doi.org/10.1016/S2213-8587(15)00030-3.
- Los autores/as conservarán sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Licencia de Creative Commons Reconocimiento- NoComercial- SinObraDerivada 4.0 Internacional. que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación esta revista.