Cardiovascular disease and endothelial dysfunction in children with chronic


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Abstract

Mortality among children with chronic kidney disease (CKD) is significantly higher than among their healthy peers, has not significantly decreased in recent decades and is associated mainly with cardiovascular complications. The main causes of cardiac death in children include arrhythmias (asystolia, ventricular fibrillation), cardiomyopathy with congestive heart failure and pulmonary edema, less often - myocardial infarction, cerebrovascular disease. Arterial hypertension is an early manifestation of cardiovascular disease and an important factor for the progression of kidney damage in CKD. It is accompanied by pathological remodeling of the vasculature and myocardium: rigidity of the vascular wall, thickening of intima-media of large arteries, left ventricle hypertrophy. Cardiovascular damage is aggravated with progression of CKD: the prevalence and severity of arterial hypertension, changes in the walls of large arteries, left ventricle hypertrophy, dilatation of the left ventricle, and dilatation of the aorta are maximal in terminal CKD. These changes are associated with a risk of heart rhythm disturbances, congestive heart failure, acute coronary artery disease - conditions that ultimately result in a reduction in the lifespan of such patients. According to modern concepts, the leading role in the development of cardiovascular damage in CKD belongs to the uremic environment, which provokes endothelial dysfunction and triggers a cascade of pathological reactions. The review considers the involvement of endothelial dysfunction in the pathogenesis of cardiovascular damage. The data of clinical and experimental studies, indicating the important role of lipid metabolism disorders, oxidative stress, imbalance of vasoconstrictors and vasodilators in the development of cardiovascular disease in children with CKD are presented.

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