The vascular endothelium in chronic renal failure

Chronic renal failure (CRF) is associated with a 20-fold increased risk of cardiovascular death, two principal mechanisms being: sudden, arrhythmic de ath associated with left ventricular hypertrophy, and ischaemic heart disea se, associated with accelerated atherosclerosis, In recent years, the vascu lar endothelium has been recognised as a large and complex endocrine organ, with many important physiological functions including the control of vascu lar tone, Endothelial dysfunction, commonly characterised by reduced produc tion of the vasodilator nitric oxide (NO), is thought to be a key initial e vent in the development of atherosclerosis and is present in patients with hypertension and hyperlipidaemia. While these cardiovascular risk factors a re also prevalent in CRF, other factors more specific to uraemia such as ac cumulation of homocysteine and asymmetric dimethylarginine (endogenous inhi bitor of NO synthase) may impair endothelial function, Modulation of endoth elial function in CRF may offer a novel strategy to reduce cardiovascular d isease.