{"id":5796,"date":"2023-10-26T15:06:19","date_gmt":"2023-10-26T20:06:19","guid":{"rendered":"https:\/\/ami.advancedrenaleducation.com\/wparep\/?post_type=article&p=5796"},"modified":"2025-05-09T21:24:11","modified_gmt":"2025-05-10T02:24:11","slug":"proteccion-endotelial-y-aterosclerosis-sp","status":"publish","type":"article","link":"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/proteccion-endotelial-y-aterosclerosis-sp\/","title":{"rendered":"Protecci\u00f3n Endotelial y Aterosclerosis"},"content":{"rendered":"

La mortalidad cardiovascular en pacientes en di\u00e1lisis es 10-20 veces mayor que en la poblaci\u00f3n general y parece ser m\u00e1s de 100 veces mayor en pacientes menores de 45 a\u00f1os (1). La etiolog\u00eda de la enfermedad cardiovascular en pacientes con enfermedad renal en etapa terminal ERET es compleja y multifactorial; La sobrecarga de volumen y presi\u00f3n, las anomal\u00edas en la morfolog\u00eda y funci\u00f3n card\u00edacas, las dislipidemias, la aterosclerosis y los trastornos nutricionales, todos influyen.<\/span><\/p>\n

En el coraz\u00f3n de la aterosclerosis hay un endotelio anormal y disfuncional. Las c\u00e9lulas progenitoras endoteliales derivadas de la m\u00e9dula \u00f3sea (CPE) son importantes para el mantenimiento del endotelio. Las CPE median la reparaci\u00f3n del endotelio vascular da\u00f1ado, promueven la angiog\u00e9nesis y protegen el vaso sangu\u00edneo del desarrollo de la aterosclerosis (2). Varios informes en la literatura describen anomal\u00edas cualitativas y cuantitativas de las CPE en pacientes ur\u00e9micos y dializados (3-7).<\/p>\n

La intensificaci\u00f3n de la prescripci\u00f3n de hemodi\u00e1lisis no tiene un efecto directo sobre el n\u00famero de c\u00e9lulas progenitoras endoteliales; sin embargo, Chan et al. plante\u00f3 la hip\u00f3tesis de que la eliminaci\u00f3n mejorada de la toxina ur\u00e9mica durante la hemodi\u00e1lisis nocturna diaria puede resultar en una mejora en el n\u00famero y la funci\u00f3n de CPE, mejorando los par\u00e1metros cardiovasculares generales en los pacientes en di\u00e1lisis. Las CPE se aislaron de 3 grupos de sujetos de la misma edad y sexo (control normal, n = 10; HD convencional, tres veces por semana (CHD), n = 12; y HD diaria, nocturna, n = 10 pacientes) (8). Ninguno de los pacientes presentaba enfermedad cardiovascular sintom\u00e1tica. La funci\u00f3n de CPE se evalu\u00f3 mediante pruebas in vitro de la respuesta migratoria a 50 ng \/ ml de factor de crecimiento endotelial vascular. El \u00edndice de masa del ventr\u00edculo izquierdo (IMVI) se obtuvo mediante ecocardiograf\u00eda 2D. El n\u00famero y la funci\u00f3n de CPE se vieron notablemente afectados en pacientes con cardiopat\u00eda coronaria a pesar de las dosis m\u00e1s altas de eritropoyetina. Por el contrario, los pacientes con NHD ten\u00edan una biolog\u00eda de CPE similar a los controles normales (Figura 1). El n\u00famero y la funci\u00f3n de CPE se correlacionan inversamente con la concentraci\u00f3n de urea previa a la di\u00e1lisis y el IMVI.<\/p>\n

\"\"<\/a><\/p>\n

Adem\u00e1s de los par\u00e1metros de CPE, varios art\u00edculos han descrito una mejor\u00eda de la dislipidemia con hemodi\u00e1lisis intensificada. Dado que esto tampoco podr\u00eda ser un efecto directo, se supone que la HD intensificada elimina mejor uno o m\u00e1s solutos que deterioran el metabolismo lip\u00eddico normal. Bugeja y cols. realiz\u00f3 un estudio de cohorte prospectivo de 11 pacientes con ERT antes y despu\u00e9s de la conversi\u00f3n de hemodi\u00e1lisis convencional a diaria (5-6 veces \/ semana) nocturna (9). Se obtuvo un perfil de l\u00edpidos en ayunas de 12 horas mientras estaba en CHD y despu\u00e9s de 3 meses en NHD estable. Tres meses despu\u00e9s de la conversi\u00f3n de CHD a NHD, se identific\u00f3 una ca\u00edda significativa en los triglic\u00e9ridos s\u00e9ricos asociada con un aumento significativo en el colesterol HDL y la relaci\u00f3n HDL\/colesterol total como se muestra en la Figura 2. El colesterol total y el colesterol LDL permanecieron sin cambios. Aunque los cambios de esta magnitud en el perfil de l\u00edpidos podr\u00edan considerarse como una respuesta cl\u00ednicamente significativa a cualquier otro tratamiento hipolipemiante, debe tenerse en cuenta que los ensayos controlados aleatorios con f\u00e1rmacos hipolipemiantes (estatinas) no han mostrado ninguna mejora en los resultados cl\u00ednicos en pacientes en mantenimiento. HD (10-11).<\/p>\n

\"\"<\/a><\/p>\n

 <\/p>\n

<\/div>
<\/div>\n

Referencias:<\/strong><\/h4>\n
    \n
  1. Foley RN, Parfrey PS, Sarnak MJ. Epidemiology of cardiovascular disease in chronic renal disease. J Am Soc Nephrol<\/em>. 1998;9(12 Suppl):S16-23. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11443763.<\/li>\n
  2. Hill JM, Zalos G, Halcox JPJ, Schenke WH, Waclawiw MA, Quyyumi AA, Finkel T. Circulating endothelial progenitor cells, vascular function, and cardiovascular risk. N Engl J Med<\/em>. 2003;348(7):593-600. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12584367.<\/li>\n
  3. Bahlmann FH, DeGroot K, Duckert T, Niemczyk E, Bahlmann E, Boehm SM, Haller H, Fliser D. Endothelial progenitor cell proliferation and differentiation is regulated by erythropoietin. Kidney Int<\/em>. 2003;64(5):1648-1652. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14531796.<\/li>\n
  4. Chen Y-LY-T, Cheng B-C, Ko S-F, Chen C-H, Tsai T-H, Leu S, Chang H-W, Chung S-Y, Chua S, Yeh K-H, et al. Value and level of circulating endothelial progenitor cells, angiogenesis factors and mononuclear cell apoptosis in patients with chronic kidney disease. Clin Exp Nephrol<\/em>. 2013;17(1):83-91. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22814956.<\/li>\n
  5. Jourde-Chiche N, Dou L, Sabatier F, Calaf R, Cerini C, Robert S, Camoin-Jau L, Charpiot P, Argiles A, Dignat-George F, et al. Levels of circulating endothelial progenitor cells are related to uremic toxins and vascular injury in hemodialysis patients. J Thromb Haemost<\/em>. 2009;7(9):1576-1584. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19583820.<\/li>\n
  6. Krieter DH, Fischer R, Merget K, Lemke H-D, Morgenroth A, Canaud B, Wanner C. Endothelial progenitor cells in patients on extracorporeal maintenance dialysis therapy. Nephrol Dial Transplant<\/em>. 2010;25(12):4023-4031.<\/li>\n
  7. Kun-Ying Z, Hui-Lan L, Xiao-Feng D, Guo-Gang L. Association between Circulating Endothelial Cells and Carotid Atherosclerosis in Patients Receiving Maintenance Hemodialysis. 2014. Available from: http:\/\/dx.doi.org\/10.1155\/2014\/753759.<\/li>\n
  8. Chan CT, Li SH, Verma S. Nocturnal hemodialysis is associated with restoration of impaired endothelial progenitor cell biology in end-stage renal disease. Am J Physiol Renal Physiol<\/em>. 2005;289(4):F679-84. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15928211.<\/li>\n
  9. Bugeja AL, Chan CT. Improvement in lipid profile by nocturnal hemodialysis in patients with end-stage renal disease. ASAIO J<\/em>. 2004;50(4):328-331. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15307542.<\/li>\n
  10. Wanner C, Krane V, M\u00e4rz W, Olschewski M, Mann JFE, Ruf G, Ritz E. Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med<\/em>. 2005;353(3):238-248. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16034009.<\/li>\n
  11. Fellstr\u00f6m BC, Jardine AG, Schmieder RE, Holdaas H, Bannister K, Beutler J, Chae D-W, Chevaile A, Cobbe SM, Gr\u00f6nhagen-Riska C, et al. Rosuvastatin and cardiovascular events in patients undergoing hemodialysis. N Engl J Med<\/em>. 2009;360(14):1395-1407. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19332456.<\/span><\/li>\n<\/ol>\n

    P\/N 102559-01S Rev B 02\/2023 <\/span><\/p>\n

    <\/div>\n","protected":false},"featured_media":0,"template":"","format":"standard","meta":{"_acf_changed":false},"categories":[274],"tags":[216],"language":[42],"articles":[271],"class_list":["post-5796","article","type-article","status-publish","format-standard","hentry","category-articulos","tag-hhd1-sp","language-spanish","articles-hemodialisis-domiciliaria","entry","no-media"],"acf":[],"yoast_head":"\nProtecci\u00f3n Endotelial y Aterosclerosis - Advanced Renal Education Program<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/proteccion-endotelial-y-aterosclerosis-sp\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Protecci\u00f3n Endotelial y Aterosclerosis - Advanced Renal Education Program\" \/>\n<meta property=\"og:description\" content=\"La mortalidad cardiovascular en pacientes en di\u00e1lisis es 10-20 veces mayor que en la poblaci\u00f3n general y parece ser m\u00e1s de 100 veces mayor en pacientes menores de 45 a\u00f1os (1). La etiolog\u00eda de la enfermedad cardiovascular en pacientes con…\" \/>\n<meta property=\"og:url\" content=\"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/proteccion-endotelial-y-aterosclerosis-sp\/\" \/>\n<meta property=\"og:site_name\" content=\"Advanced Renal Education Program\" \/>\n<meta property=\"article:modified_time\" content=\"2025-05-10T02:24:11+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/ami.advancedrenaleducation.com\/wparep\/wp-content\/uploads\/2023\/08\/102559_fig1.png\" \/>\n\t<meta property=\"og:image:width\" content=\"936\" \/>\n\t<meta property=\"og:image:height\" content=\"398\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/proteccion-endotelial-y-aterosclerosis-sp\/\",\"url\":\"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/proteccion-endotelial-y-aterosclerosis-sp\/\",\"name\":\"Protecci\u00f3n Endotelial y Aterosclerosis - Advanced Renal Education Program\",\"isPartOf\":{\"@id\":\"https:\/\/ami.advancedrenaleducation.com\/wparep\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/proteccion-endotelial-y-aterosclerosis-sp\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/proteccion-endotelial-y-aterosclerosis-sp\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/ami.advancedrenaleducation.com\/wparep\/wp-content\/uploads\/2023\/08\/102559_fig1.png\",\"datePublished\":\"2023-10-26T20:06:19+00:00\",\"dateModified\":\"2025-05-10T02:24:11+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/proteccion-endotelial-y-aterosclerosis-sp\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/proteccion-endotelial-y-aterosclerosis-sp\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/proteccion-endotelial-y-aterosclerosis-sp\/#primaryimage\",\"url\":\"https:\/\/ami.advancedrenaleducation.com\/wparep\/wp-content\/uploads\/2023\/08\/102559_fig1.png\",\"contentUrl\":\"https:\/\/ami.advancedrenaleducation.com\/wparep\/wp-content\/uploads\/2023\/08\/102559_fig1.png\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/proteccion-endotelial-y-aterosclerosis-sp\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/ami.advancedrenaleducation.com\/wparep\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Protecci\u00f3n Endotelial y Aterosclerosis\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/ami.advancedrenaleducation.com\/wparep\/#website\",\"url\":\"https:\/\/ami.advancedrenaleducation.com\/wparep\/\",\"name\":\"Advanced Renal Education Program\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\/\/ami.advancedrenaleducation.com\/wparep\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/ami.advancedrenaleducation.com\/wparep\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/ami.advancedrenaleducation.com\/wparep\/#organization\",\"name\":\"Advanced Renal Education Program\",\"url\":\"https:\/\/ami.advancedrenaleducation.com\/wparep\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/ami.advancedrenaleducation.com\/wparep\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/ami.advancedrenaleducation.com\/wparep\/wp-content\/uploads\/2023\/03\/1Asset-1.jpg\",\"contentUrl\":\"https:\/\/ami.advancedrenaleducation.com\/wparep\/wp-content\/uploads\/2023\/03\/1Asset-1.jpg\",\"width\":1965,\"height\":381,\"caption\":\"Advanced Renal Education Program\"},\"image\":{\"@id\":\"https:\/\/ami.advancedrenaleducation.com\/wparep\/#\/schema\/logo\/image\/\"}}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Protecci\u00f3n Endotelial y Aterosclerosis - Advanced Renal Education Program","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/proteccion-endotelial-y-aterosclerosis-sp\/","og_locale":"en_US","og_type":"article","og_title":"Protecci\u00f3n Endotelial y Aterosclerosis - Advanced Renal Education Program","og_description":"La mortalidad cardiovascular en pacientes en di\u00e1lisis es 10-20 veces mayor que en la poblaci\u00f3n general y parece ser m\u00e1s de 100 veces mayor en pacientes menores de 45 a\u00f1os (1). La etiolog\u00eda de la enfermedad cardiovascular en pacientes con…","og_url":"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/proteccion-endotelial-y-aterosclerosis-sp\/","og_site_name":"Advanced Renal Education Program","article_modified_time":"2025-05-10T02:24:11+00:00","og_image":[{"width":936,"height":398,"url":"https:\/\/ami.advancedrenaleducation.com\/wparep\/wp-content\/uploads\/2023\/08\/102559_fig1.png","type":"image\/png"}],"twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"5 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/proteccion-endotelial-y-aterosclerosis-sp\/","url":"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/proteccion-endotelial-y-aterosclerosis-sp\/","name":"Protecci\u00f3n Endotelial y Aterosclerosis - Advanced Renal Education Program","isPartOf":{"@id":"https:\/\/ami.advancedrenaleducation.com\/wparep\/#website"},"primaryImageOfPage":{"@id":"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/proteccion-endotelial-y-aterosclerosis-sp\/#primaryimage"},"image":{"@id":"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/proteccion-endotelial-y-aterosclerosis-sp\/#primaryimage"},"thumbnailUrl":"https:\/\/ami.advancedrenaleducation.com\/wparep\/wp-content\/uploads\/2023\/08\/102559_fig1.png","datePublished":"2023-10-26T20:06:19+00:00","dateModified":"2025-05-10T02:24:11+00:00","breadcrumb":{"@id":"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/proteccion-endotelial-y-aterosclerosis-sp\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/proteccion-endotelial-y-aterosclerosis-sp\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/proteccion-endotelial-y-aterosclerosis-sp\/#primaryimage","url":"https:\/\/ami.advancedrenaleducation.com\/wparep\/wp-content\/uploads\/2023\/08\/102559_fig1.png","contentUrl":"https:\/\/ami.advancedrenaleducation.com\/wparep\/wp-content\/uploads\/2023\/08\/102559_fig1.png"},{"@type":"BreadcrumbList","@id":"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/proteccion-endotelial-y-aterosclerosis-sp\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/ami.advancedrenaleducation.com\/wparep\/"},{"@type":"ListItem","position":2,"name":"Protecci\u00f3n Endotelial y Aterosclerosis"}]},{"@type":"WebSite","@id":"https:\/\/ami.advancedrenaleducation.com\/wparep\/#website","url":"https:\/\/ami.advancedrenaleducation.com\/wparep\/","name":"Advanced Renal Education Program","description":"","publisher":{"@id":"https:\/\/ami.advancedrenaleducation.com\/wparep\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/ami.advancedrenaleducation.com\/wparep\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/ami.advancedrenaleducation.com\/wparep\/#organization","name":"Advanced Renal Education Program","url":"https:\/\/ami.advancedrenaleducation.com\/wparep\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/ami.advancedrenaleducation.com\/wparep\/#\/schema\/logo\/image\/","url":"https:\/\/ami.advancedrenaleducation.com\/wparep\/wp-content\/uploads\/2023\/03\/1Asset-1.jpg","contentUrl":"https:\/\/ami.advancedrenaleducation.com\/wparep\/wp-content\/uploads\/2023\/03\/1Asset-1.jpg","width":1965,"height":381,"caption":"Advanced Renal Education Program"},"image":{"@id":"https:\/\/ami.advancedrenaleducation.com\/wparep\/#\/schema\/logo\/image\/"}}]}},"distributor_meta":false,"distributor_terms":false,"distributor_media":false,"distributor_original_site_name":"Advanced Renal Education Program","distributor_original_site_url":"https:\/\/ami.advancedrenaleducation.com\/wparep","push-errors":false,"_links":{"self":[{"href":"https:\/\/ami.advancedrenaleducation.com\/wparep\/wp-json\/wp\/v2\/article\/5796","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ami.advancedrenaleducation.com\/wparep\/wp-json\/wp\/v2\/article"}],"about":[{"href":"https:\/\/ami.advancedrenaleducation.com\/wparep\/wp-json\/wp\/v2\/types\/article"}],"wp:attachment":[{"href":"https:\/\/ami.advancedrenaleducation.com\/wparep\/wp-json\/wp\/v2\/media?parent=5796"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ami.advancedrenaleducation.com\/wparep\/wp-json\/wp\/v2\/categories?post=5796"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ami.advancedrenaleducation.com\/wparep\/wp-json\/wp\/v2\/tags?post=5796"},{"taxonomy":"language","embeddable":true,"href":"https:\/\/ami.advancedrenaleducation.com\/wparep\/wp-json\/wp\/v2\/language?post=5796"},{"taxonomy":"articles","embeddable":true,"href":"https:\/\/ami.advancedrenaleducation.com\/wparep\/wp-json\/wp\/v2\/articles?post=5796"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}