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Organ and Metabolic Complications: Lipids/Atherosclerosis

  • Eberhard Ritz
  • Michal Nowicki
  • Andrzej Wiecek

Abstract

The incidence of and mortality from atherosclerotic complications, particulary coronary atherosclerosis, is strikingly increased in dialysed patients. One of the factors involved is dyslipoproteinemia. The main cause of dyslipoproteinemia is reduced activity of enzymes catabolising lipoproteins (hepatic triglyceride lipase, lipoprotein lipase), but additional abnormalities clearly contribute. Specific patterns of dyslipoproteinemia are present in patients with the nephrotic syndrome, diabetes mellitus and with immunosuppression (steroids, cyclosporin A). A paradoxical inverse relationship is noted between several lipid indicators and cardiac mortality in dialysis patients. This is presumably due to the confounding effect of malnutrition. Lipid indicators like Lp(a) and apolipoprotein ratios (AI/CIII) are predictive of atherosclerotic vascular disease, however, particularly in the high risk population of diabetics

Keywords

Chronic Renal Failure Dialysis Patient Lipoprotein Lipase Metabolic Complication Nephrol Dial Transplant 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Lindner A, Charra B, Sherrard D, Scribner BM: Accelerated atherosclerosis in prolonged maintenance hemodialysis. N Engl J Med 290: 697, 1974PubMedCrossRefGoogle Scholar
  2. 2. Combined Report on Regular Dialysis and Transplantation in Europe XXII, 1991: Nephrol Dial Transplant 7 (Suppl 2):5, 1992Google Scholar
  3. 3.
    Ritz E, Strumpf C, Katz F, Wing AJ, Quellhorst E: Hypertension and cardiovascular risk factors in hemodialyzed diabetic patients. Hypertension 7(Suppl II): II–118, 1985Google Scholar
  4. 4.
    Ritz E, Wiecek A, Rambausek M: Cardiovascular death in patients with end-stage renal failure; strategies for prevention. International Yearbook Nephrol Dial Transplant 9(Suppl): 120, 1994Google Scholar
  5. 5.
    Ritz E, Deppisch R, Stier E, Hansch G: Atherogenesis and cardiac death: are they related to dialysis procedures and biocompatibility? Nephrol Dial Transplant 9(Suppl 2): 165, 1994PubMedGoogle Scholar
  6. 6.
    Bright R: Response of Medical Cases Selected with a View of Illustrating the Symptoms and Cures of Diseases by Reference to Morbid Anatomy, London, Longman, Rus Orme, Brown and Greene, 1827Google Scholar
  7. 7.
    Bloor WR: The blood lipids in nephritis. J Biol Chem 31: 575, 1917Google Scholar
  8. 8.
    Bagdade JD, Shafrir E, Wilson D: Mechanism(s) of hyperlipidemia in chronic uremia. Trans Am Soc Artif Organs 22: 42, 1976Google Scholar
  9. 9.
    Gnasso A, Haberbosch W, Augustin J, Ritz E: Abnormal lipoprotein metabolism in incipient renal failure. Proc EDTA-ERA 22: 1129, 1985Google Scholar
  10. 10.
    Attman PO, Alaupovic P: Lipid and apolipoprotein profiles of uremic dyslipoproteinemia — relation to renal function and dialysis. Nephron 57: 401, 1991PubMedGoogle Scholar
  11. 11.
    Kaysen GA, Pan XM, Couser WG, Staprans I: Defective lipolysis persists in hearts of rats with Heymann nephritis in the absence of nephrotic plasma. Am J Kidney Dis 22: 128, 1993PubMedGoogle Scholar
  12. 12.
    Tschöpe W, Koch M, Thomas B, Ritz E: Serum lipids predict cardiac death in diabetic patients on maintenance hemodialysis (results of a prospective study). Nephron 64: 354, 1993PubMedGoogle Scholar
  13. 13.
    Vathsala A, Weinberg RB, Schoenberg L et al.: Lipid abnormalities in cyclosporine-prednisone treated renal transplant recipients. Transplantation 48: 37, 1989PubMedGoogle Scholar
  14. 14.
    Weintraub M, Burstein A, Rassin T et al.: Severe defect in clearing postprandial chylomicron remnants in dialysis patients. Kidney Int 42: 1247, 1992PubMedGoogle Scholar
  15. 15.
    Nestel PJ, Fidge NH, Tan MH: Increased lipoprotein-remnant formation in chronic renal failure. N Engl J Med 307: 329, 1982PubMedCrossRefGoogle Scholar
  16. 16.
    Mordasini R, Frey F, Flury W, Klose G, Greten H: Selective deficiency of hepatic triglyceride lipase in uremic patients. N Engl J Med 297: 1362, 1977PubMedCrossRefGoogle Scholar
  17. 17.
    Druml W, Zechner R, Magometschnigg D: Post-heparin lipolytic activity in acute renal failure. Clin Nephrol 23: 289, 1985PubMedGoogle Scholar
  18. 18.
    Gonen B, Goldberg AP, Harter HR, Schonfeld G: Abnormal cell-interactive properties of low-density lipoproteins isolated from patients with chronic renal failure. Metabolism 34: 10, 1985PubMedGoogle Scholar
  19. 19.
    Takemura T, Yoshioka K, Aya N: Apolipoproteins and lipoprotein receptors in glomeruli in human kidney diseases. Kidney Int 43: 918, 1993PubMedGoogle Scholar
  20. 20.
    Hörkko S, Savolainen MJ, Kervinen K, Kesäniemi YA: Carbamylation-induced alterations in low-density lipoprotein metabolism. Kidney Int 41: 1175, 1992PubMedGoogle Scholar
  21. 21.
    Ritz E, Deppisch R, Nawroth P: Toxicity of uraemia — does it come of AGE. Nephrol Dial Transplant 9: 1, 1994PubMedGoogle Scholar
  22. 22.
    Walidius G, Norbeck JE: Effective fatty acid incorporation into adipose tissue (FIAT) in uremic subjects with hypertriglyceridemia. Eur J Clin Invest 8: 346, 1978Google Scholar
  23. 23.
    Attman PO, Alaupovic P, Gustafson A: Serum apolipoprotein profile of patients with chronic renal failure. Kidney Int 32: 368, 1987PubMedGoogle Scholar
  24. 24.
    Webb AT, Reaveley DA, O’Donnell M, O’Connor B, Seed M, Brown EA: Lipoprotein (a) in patients on maintenance haemodialysis and continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant 8: 609, 1993PubMedGoogle Scholar
  25. 25.
    Dieplinger H, Lackner C, Kronenberg F et al.: Elevated plasma concentrations of lipoprotein (a) in patients with end-stage renal disease are not related to the size polymorphism of apolipoprotein (a). J Clm Invest 91: 397, 1993Google Scholar
  26. 26.
    Scott J: Arterial hardening in mice. Nature 360: 631, 1992PubMedGoogle Scholar
  27. 27.
    Cressman MD, Heyka RJ, Paganini EP, O’Neil J, Skibinski CI, Hoff HF: Lipoprotein (a) is an independent risk factor for cardiovascular disease in hemodialysis patients. Circulation 86: 475, 1992PubMedGoogle Scholar
  28. 28.
    Daerr WH, Windier ETE, Greten H: Peroxidatiive modification of very-low density lipoproteins in chronic hemodialysis patients. Nephron 63: 230, 1993PubMedGoogle Scholar
  29. 29.
    Paul JL, Sail ND, Soni T et al.: Lipid peroxidation abnormalities in hemodialyzed patients. Nephron 64: 106, 1993PubMedGoogle Scholar
  30. 30.
    Guijarro C, Keane WF: Lipid abnormalities and changes in plasma proteins in glomerular diseases and chronic renal failure. Curr Opinion in Nephrol Hypertens 2: 372, 1993CrossRefGoogle Scholar
  31. 31.
    Kasiske BL, O’Donnell MP, Cowardin W, Keane WF: Lipids and the kidney. Hypertension 15: 443, 1990PubMedGoogle Scholar
  32. 32.
    Walli AK, Gröne E, Miller B, Gröne HJ, Thiery J, Seidel D: Role of lipoproteins in progressive renal disease. Am J Hypertens 6: 358S, 1993Google Scholar
  33. 33.
    Maggi E, Bellazzi R, Falaschi F et al.: Enhanced LDL oxidation in uremic patients: an additional mechanism for accelerated atherosclerosis. Kidney Int 45: 876, 1994PubMedGoogle Scholar
  34. 34.
    Ritz E, Querfeld U: Atherosclerosis — is it accelerated in uremia? Semin Dial 2: 246, 1989Google Scholar
  35. 35.
    Attman PO, Nyberg G, William-Olsson T, Knight-Gibson C, Alaupovic P: Dyslipoproteinemia in diabetic renal failure. Kidney Int 42: 1381, 1992PubMedGoogle Scholar
  36. 36.
    Massry SG, Akmal M: Lipid abnormalities, renal failure and parathyroid hormone. Am J Med 87(Suppl 5): 42N, 1989PubMedGoogle Scholar
  37. 37.
    Mak RHK, DeFronzo RA: Glucose and insulin metabolism in uremia. Nephron 61: 377, 1992PubMedCrossRefGoogle Scholar
  38. 38.
    Cattran DC, Fenton SA, Wilson DR, Steiner G: Defective triglyceride removal in lipemia associated with peritoneal dialysis and hemodialysis. Ann Intern Med 85: 29, 1976PubMedGoogle Scholar
  39. 39.
    Chan MK, Persaud J, Varghese Z, Moorhead JF: Pathogenic roles of post-heparin lipases in lipid abnormalities in hemodialysis patients. Kidney Int 25: 812, 1984PubMedGoogle Scholar
  40. 40.
    Josephson MA, Fellner SK, Dasguptam A: Improved lipid profiles in patients undergoing high-flux hemodialysis. Am J Kidney Dis 20: 361, 1992PubMedGoogle Scholar
  41. 41.
    Blankestijn PJ, Vos PF, Rabelink AJ, van Rijn H, Jansen H, Koomans HA: High-flux dialysis membranes improve lipid profiles in hemodialysis patients. J Am Soc Nephrol 4: 334A, 1993Google Scholar
  42. 42.
    Akiba T, Tachibana K, Ozawa K et al.: Long-term use of low molecular weight heparin ameliorates hyperlipidemia in patients on hemodialysis. ASAIO J 38: M326, 1992PubMedGoogle Scholar
  43. 43.
    Schrader J, Stibbe W, Armstrong VW et al.: Comparison of low-molecular weight heparin to standard heparin in hemodialysis/hemofiltration. Kidney Int 33: 890, 1988PubMedGoogle Scholar
  44. 44.
    Heuck CC, Ritz E: Hyperlipoproteinemia in renal insufficiency. Nephron 25: 1, 1980PubMedGoogle Scholar
  45. 45.
    Kluge R, Heuck CC, Ritz E: Lipidstoffwechsel unter Bikarbonatdialyse. Nieren Hochdruckkrankheiten 13: 143, 1984Google Scholar
  46. 46.
    DeFronzo RA, Tobin JD, Rowe JW, Adres R. Glucose intolerance of uremia. Quantification of pancreatic beta cell sensitivity to glucose and tissue sensitivity to insulin. J Clin Invest 62: 425, 1978PubMedGoogle Scholar
  47. 47.
    Maloff B, Lockwood D: Cellular basis for insulin resistance in uremia. Diabetes 30(Suppl 1): 28, 1981Google Scholar
  48. 48.
    Ramos JM, Hetaon A, McGurk JG, Ward MK, Kerr DNS; Sequential changes in serum lipids and their subfractions in patients receiving continuous ambulatory peritoneal dialysis. Nephron 33: 20, 1983Google Scholar
  49. 49.
    Clyne N, Lind LE, Pehrsson K: Ischemic heart disease in uremia. Proc EDTA-ERA 20: 25A, 1983Google Scholar
  50. 50.
    Vincenti F, Amend WJ, Abele J, Feduska NJ, Salvatierra O: The role of hypertension in hemodialysis-associated atherosclerosis. Am J Med 68: 363, 1980PubMedGoogle Scholar
  51. 51.
    Ikram H, Lynn KL, Bailey RR, Littel PJ: Cardiovascular changes in chronic hemodialysis patients. Kid Int 24: 371, 1983Google Scholar
  52. 52.
    Kramer W, Thormann J, Kindler M, Müller K, Wizemann W: Uramische Herzkrankheit. II. Ventrikeldynamik bei terminaler Niereninsuffizienz im Vergleich zur idiopathisch-dilatativen Kardiomyopathie. Med Welt 36: 1317, 1985Google Scholar
  53. 53.
    Braun WE, Phillips D, Vidt DG et al.: Coronary artery disease in terminal renal failure. Transplant Proc 113: 128, 1981Google Scholar
  54. 54.
    Hässler R, Hofling B, Castro L et al.: Koronare Herzkrankheit und Herzklappenerkrankung bei Patienten mit terminaler Niereninsuffizienz. Dtsch Med Wschr 112: 714, 1987PubMedCrossRefGoogle Scholar
  55. 55.
    Rostand SG, Kirk KA, Rutsky EA: Dialysis-associated ischemic heart disease: insights form coronary angiography. Kidney Int 25: 653, 1984PubMedGoogle Scholar
  56. 56.
    Rostand SG, Rutsky EA: Ischemic heart disease in chronic renal failure. Sem Dial 2: 98, 1989Google Scholar
  57. 57.
    Bennet WM, Kloster F, Rosch J et al.: Natural history of asymptomatic coronary arteriographic lesions in diabetic patients with end-stage renal disease. Am J Med 15: 779, 1978Google Scholar
  58. 58.
    Braun WE, Phillips DF, Vidt DT et al.: Coronary disease in 100 diabetics with end-stage renal failure. Transplant Proc 16: 603, 1984PubMedGoogle Scholar
  59. 59.
    Ansari A, Kaupke CJ, Vaziri ND, Miller R, Barbari A: Cardiac pathology in patients with end-stage renal disease maintained on hemodialysis. Int J Artif Organs 16: 31, 1993PubMedGoogle Scholar
  60. 60.
    Fliser D, Schweizer C, Ritz E: How many patients with renal insufficiency survive until end-stage renal failure (letter). Nephrol Dial Transplant 6: 600, 1991PubMedGoogle Scholar
  61. 61.
    Manske CL, Thomas W, Wang Y, Wilson RF: Screening diabetic transplant candidates for coronary artery disease: identification of a low risk group. Kidney Int 44: 617, 1993PubMedGoogle Scholar
  62. 62.
    Horsch A, Ritz E, Heuck CC, Hofmann W, Kuhne E, Bisson M: Atherogenesis in experimental uremia. Atherosclerosis 40: 279, 1981PubMedGoogle Scholar
  63. 63.
    Kamstrup P, Tyedegaard E, Stender S: Effect of chronic uremia on plasma lipids and the aortic accumulation of cholesterol in hypercholesterolemic rabbits. Nephron 26: 280, 1980PubMedGoogle Scholar
  64. 64.
    Kamstrup O, Tvedegaard E: Increased uptake of cholesterol and increased mineral content in the aorta of longterm uremic rabbits. Nephron 33: 267, 1983PubMedGoogle Scholar
  65. 65.
    Fiegel P, Abdelhamid S, Meves M, Walb D, Thomas L: HDL-und LDL-Cholesterin und Gefäßverkalkungen bei Dialysepatienten. Dialysenarztetreffen Innsbruck, 1982Google Scholar
  66. 66.
    Rinehart AL, Herzog CA, Collins AJ, Flack JM, Ma JZ, Opsahl JA: Greater risk of cardiac events after coronary angioplasty (PTCA) than bypass grafting (CABG) in chronic dialysis patients. J Am Soc Nephrol 3: 389, 1992Google Scholar
  67. 67.
    Chauveau P, Chadefaux B, Coude M et al.: Hyperhomocysteinemia, a risk factor for atherosclerosis in chronic uremic patients. Kidney Int 43(Suppl 41): S72, 1993Google Scholar
  68. 68.
    Vallance P, Leone A, Calver A, Collier J, Moncada S. Accumulation of an endogenous inhibitor of nitric oxide synthesis in chronic renal failure. Lancet 339: 572, 1992PubMedGoogle Scholar
  69. 69.
    Wystrychowski A, Strauss H, Wagner J, Haufe CC, Ganten D, Ritz E: Decreased responsiveness of the renal vasculature to inhibition of nitric oxide (NO) after subtotal nephrectomy. J Am Soc Nephrol 3: 557A, 1992Google Scholar
  70. 70.
    Makita Z, Bucala R, Raufield EJ et al.: Efficiency of removal of circulating advanced glycosylation end products and mode of treatment in patients with ESRD. J Am Soc Nephrol 4: 335A, 1992Google Scholar
  71. 71.
    Kaiser JP, Götze O, Göhl H, Asmus G, Schäfer K: Hemofiltration but not hemodialysis leads to an impressive reduction of factor D in uremia. J Am Soc Nephrol 3: 372A, 1992Google Scholar
  72. 72.
    Seifert PS, Messner M, Roth J, Bhakdi S: Analysis of complement C3 activation product in human atherosclerotic lesions. Atherosclerosis 91: 155, 1991PubMedGoogle Scholar
  73. 73.
    Freemen DJ, Griffin BA, Murray E et al.: Smoking and plasma lipoproteins in man: effects on low-density lipoprotein cholestrol levels and high density lipoprotein subfraction distribution. Eur J Clin Invest 23: 630, 1993Google Scholar
  74. 74.
    Davis JW, Arnold J, Wiegemann T: Cigarette smoking affects platelet and endothelium in chronic hemodialysis patients. Nephron 64: 359, 1993PubMedGoogle Scholar
  75. 75.
    Remuzzi G, Benigni A, Dodesini P et al.: Reduced platelet thromboxane formation in uremia. J Clin Invest 71:762, 1983PubMedCrossRefGoogle Scholar
  76. 76.
    Koch M, Thomas B, Tschöpe W, Ritz E: Survival and predictors of death in dialysed diabetic patients. Diabetologia 36: 1113, 1993PubMedGoogle Scholar
  77. 77.
    Degoulet P, Legrain M, Reach J, Aime F, Devries C, Rojas P, Jacobs C: Mortality risk factors in patients treated by chronic hemodialysis. Report of the Diaphane collaborative study. Nephron 31: 103, 1982PubMedGoogle Scholar
  78. 78.
    Avram MM, Goldwasser P, Burrell DE, Antignani A, Fein PA, Mittman N: The uremic dyslipidemia: a crosssectional and longitudinal study. Am J Kidney Dis 10: 324, 1992Google Scholar
  79. 79.
    Goldwasser P, Michel MA, Collier J: Prealbumin and lipoprotein (a) in hemodialysis: relationships with patients and vascular access survival. Am J Kidney Dis 22:215, 1993PubMedGoogle Scholar
  80. 80.
    Lowrie EG, Lew NL, Huang WH: Race and diabetes as death risk predictors in hemodialysis patients. Kidney Int 42: 22, 1992Google Scholar
  81. 81.
    Held P, Blagg C, Liska DW, Port FK, Hakim R, Levin N: The dose of hemodialysis according to dialysis prescription in Europe and the United States. Kidney Int 42: 16, 1992Google Scholar
  82. 82.
    Ritz E, Vallance P, Nowicki M: The effect of malnutrition on cardiovascular mortality in dialysis patients: is L-arginine the answer? Nephrol Dial Transplant 9: 129, 1994PubMedGoogle Scholar
  83. 83.
    Heuck CC, Ritz E, Liersch M, Mehls O: Serum lipids in renal insufficiency. Am J Clin Nutr 31: 1547, 1978PubMedGoogle Scholar
  84. 84.
    Sanfelippo ML, Swenson RS, Reaven GM: Reduction of plasma triglycerides by diet in subjects with chronic renal failure. Kidney Int 11: 54, 1977PubMedGoogle Scholar
  85. 85.
    Sanfelippo ML, Swenson RS, Reaven GM: Response of plasma triglycerides to dietary change in patients on hemodialysis. Kidney Int 14: 180, 1978PubMedGoogle Scholar
  86. 86.
    Cattran DC, Steiner G, Fenion SSA, Ampil M: Dialysis hyperlipemia: response to dietary manipulation. Clin Nephrol 13: 177, 1980PubMedGoogle Scholar
  87. 87.
    Yasugi T: Effect of dietary treatment on lipolytic activities and lipids and lipoproteins in patients with uremia. in Atherosclerosis, edited by Schettler G, Goho AM, Habernicht AGR, Gjuricka KR, Springer Verlag, Berlin, 1983, p 1251Google Scholar
  88. 88.
    Okubo M, Tsukamoto Y, Yoneda T, Hommma Y, Nakamura H, Marumo F: Deranged fat metabolism and the lowering effect of carbohydrate poor diet on serum triglycerides in patients with chronic renal failure. Nephron 25: 8, 1980PubMedGoogle Scholar
  89. 89.
    Ritz E, Augustin J, Bommer J, Gnasso A, Haberbosch W: Should hyperlipemia of renal failure be treated? Kidney Int 28:S84, 1985Google Scholar
  90. 90.
    Goldwasser P, Mittman N, Antignati A et al.: Predictors of mortality in hemodialysis patients. J Am Soc Nephrol 3: 1613, 1993PubMedGoogle Scholar
  91. 91.
    Goldberg AP, Geltman EM, Gavin JR et al.: Exercise training reduces coronary risk and effectively rehabilitates hemodialysis patients. Nephron 42: 311, 1986PubMedGoogle Scholar
  92. 92.
    Pierides AM, Alverez-Ude F, Kerr DNS: Clofibrate induced muscle damage in patients with chronic renal failure. Lancet 2: 1279, 1975PubMedGoogle Scholar
  93. 93.
    Pasternack A, Vänttinen T, Solakivi T, Kuusi T, Korte T: Normalization of lipoprotein lipase and hepatic lipase by gemfimbrozil results in correction of lipoprotein abnormalities in chronic renal failure. Clin Nephrol 27: 163, 1987PubMedGoogle Scholar
  94. 94.
    Nishizawa Y, Shoji T, Nishitani H et al.: Hypertriglyceridemia and lowered apolipoprotein C-II/CC-III ratio in uremia, effect of a fibric acid, clinofibrate. Kidney Int 44: 1352, 1993PubMedGoogle Scholar
  95. 95.
    Kijima Y, Sasaoka T, Kanayama M, Kubota S: Untoward effects of clofibrate in hemodialyzed patients. N Engl J Med 296:515, 1977PubMedGoogle Scholar
  96. 96.
    Wanner C, Hörl W, Luley CH, Wieland H. Effects of HMG-CoA reductase inhibitors in hypercholesterolemic patients on hemodialysis. Kidney Int 39: 754, 1991PubMedGoogle Scholar
  97. 97.
    Grundy SM: Management of hyperlipidemia of kidney disease. Kidney Int 37: 847, 1990PubMedGoogle Scholar
  98. 98.
    Fiorini F, Patrone E, Ardu F, Castellucio A: Efficacy and safety of simvastatin in the treatment of hyperlipidemia in uremic patients undergoing hemodialysis. Minerva Urol Nephrol 44: 165, 1992Google Scholar
  99. 99.
    Bilo HJG, Homan van der Heide JJ, Gans ROB, Donker AJM: Omega-3 polyunsaturated fatty acids In chronic renal insufficiency. Nephron 57: 385, 1991PubMedGoogle Scholar
  100. 100.
    Scharchmidt LA, Gibbons NB, McGarry L et al.: Effects of dietary fish oil on renal insufficiency in rats with subtotal nephrectomy. Kidney Int 32: 700, 1987Google Scholar
  101. 101.
    Bosch T, Thiery J, Gurland HJ, Seidel D: Long-term efficiency, biocompatibility, and clinical safety of combined simultaneous LDL-apheresis and haemodialysis in patients with hypercholesterolaemia and end-stage renal failure. Nephrol Dial Transplant 8: 1350, 1993PubMedGoogle Scholar
  102. 102.
    Silberberg JS, Barre PE, Pichard SS, Sniderman AD: Impact of left ventricular hypertrophy on survival in end-stage renal disease. Kidney Int 36: 286, 1989PubMedGoogle Scholar
  103. 103.
    London G, Guerin A, Pannier B, Marchais S, Benetos S, Safar M: Increased systolic pressure in chronic uremia. Role of arterial wave reflections. Hypertension 20: 10, 1992PubMedGoogle Scholar
  104. 104.
    Wizemann V, Kaufmann J, Kramer W: Effect of erythropoietin on ischemia tolerance in anemic hemodialysis patients with confirmed coronary artery disease. Nephron 62: 161, 1992PubMedGoogle Scholar
  105. 105.
    Amann K, Wiest G, Irzyniec T, Neusüß R, Ritz E, Mall G: Changes of vascular architecture independent of blood pressure in experimental uremia. J Hypertens In pressGoogle Scholar
  106. 106.
    Amann K, Wiest G, Zimmer G, Gretz N, Ritz E, Mall G: Reduced capillary density in the myocardium of uremic rats. A stereological study. Kidney Int 42: 1079, 1992PubMedGoogle Scholar
  107. 107.
    Cleminson WG, Manchester KL, Diesel WJ, Margolins LP: Adenine nucleotide concentrations and energy charge in muscle of chronic haemodialysis patients. Nephron 60: 232, 1992PubMedGoogle Scholar
  108. 108.
    Bigazzi R, Kosogov E, Campese VM: Increased sympathetic nervous system activity and hypertension in rats with chronic renal failure. J Am Soc Nephrol 4: 507A, 1994Google Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • Eberhard Ritz
    • 1
  • Michal Nowicki
    • 2
  • Andrzej Wiecek
    • 3
  1. 1.Department of Internal MedicineRuperto Carola UniversityHeidelbergGermany
  2. 2.Department NephrologySilesian School of MedicineKatowicePoland
  3. 3.Department of NephrologySilesian School of MedicineKatowicePoland

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