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Therapeutic Potential of Low‐Density Lipoprotein Apheresis in the Management of Peripheral Artery Disease in Patients With Chronic Kidney Disease
Authors:Kouichi Tamura  Yuko Tsurumi‐Ikeya  Hiromichi Wakui  Akinobu Maeda  Masato Ohsawa  Kengo Azushima  Tomohiko Kanaoka  Kazushi Uneda  Sona Haku  Koichi Azuma  Hiroshi Mitsuhashi  Nobuko Tamura  Yoshiyuki Toya  Yasuo Tokita  Toshiharu Kokuho  Satoshi Umemura
Affiliation:1. Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine;2. Department of Medicine, Yokohama Dai‐ichi Hospital of Zenjin Foundation;3. Department of Nephrology and Hypertension, Yokohama Minami‐Kyosai Hospital;4. Department of Dermatology, Kanagawa Prefecture Shiomidai Hospital, Yokohama;5. Renal Division, Department of Medicine, Fujisawa Municipal Hospital, Fujisawa;6. Department of Nephrology and Hypertension, Yokosuka City Hospital, Yokosuka, Japan
Abstract:Cardiovascular disease (CVD) is a major cause of death in patients with chronic kidney disease (CKD). Patients with CKD are reported to have a significant greater risk of CVD‐associated mortality than that of the general population after stratification for age, gender, race, and the presence or absence of diabetes. CKD itself is also an independent risk factor for the development of atherosclerosis, and in particular, patients undergoing dialysis typically bear many of the risk factors for atherosclerosis, such as hypertension, dyslipidemia and disturbed calcium‐phosphate metabolism, and commonly suffer from severe atherosclerosis, including peripheral arterial disease (PAD). Low‐density lipoprotein (LDL) apheresis is a potentially valuable treatment applied to conventional therapy‐resistant hypercholesterolemic patients with coronary artery disease and PAD. Although previous and recent studies have suggested that LDL apheresis exerts beneficial effects on the peripheral circulation in dialysis patients suffering from PAD, probably through a reduction of not only serum lipids but also of inflammatory or coagulatory factors and oxidative stress, the precise molecular mechanisms underlying the long‐term effects of LDL apheresis on the improvement of the peripheral circulation remains unclear and warrants further investigation.
Keywords:Chronic kidney disease  Hemodialysis patients  Low‐density lipoprotein apheresis  Oxidative stress  Peripheral artery disease
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