Atherosclerosis in predialysis and dialysis patients with chronic renal failure

Three decades have passed since Lindner et al. (N Engl J Med 290:697-701, 1974) reported an about 10 times higher death rate from cardiovascular disease in a cohort of maintenance hemodialysis patients than in the general population. Based on the finding, they came up with an explanation that long-term maintenance hemodialysis may have accelerated atherosclerosis. However, in spite of great advances in dialysis-related medicine and technology, hemodialysis patients are still facing the very high incidence of cardiovascular disease. Why? It may not hemodialysis treatment that is responsible for atherosclerosis in patients with renal failure.