[3] 3.4 [1] [2] 36% 32.7% [4]

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1 ( ) [1] [2] [3] % 32.7% [4]

2 ( 1) (remodeling) [5] (Hyperhomocysteinemia) 1. (Age) (Gender) (Smoke) (Hypertension) (DM) (Dyslipidemia) (Hyperhomocysteinemia) (Anemia) (Chronic inflammation) (Ca P) (Hyperparathyroidism) (Vascular calcification) (Malnutrition) (Advanced glycation end products) (Endothelial dysfunction) (Insulin resistance) (Oxidative stress) (NO system dysfunction)

3 B12 [6] B12 (Hyperparathyroidism) [7] (Vascular calcification) (osteoblast) [8] (osteoblast-specific gene, cbfa-1) (Bone morphogenic protein, BMP) BMP-7 Feutin-A matrix GLA protein (MGP) [9] (Chronic inflammation) C-reactive protein(crp) Interleukin- 6(IL-6) Tumor necrosis factor α (TNF-α) fibrinogen ferritin lipoprotein(a) adiponectin (prealbumin) [10] CRP high sensitivity CRP MIA (Malnutrition, Inflammation, Atherosclerosis syndrome) [11] (Metabolic syndrome) ( ) (Insulin resistance) [5] (Oxidative stress) (scavenging systems) (Reactive oxygen species, ROS)

4 (NO) [12] (Bone marrow-derived endothelial precursor cells) [13] ADMA (asymmetrical dimethyl-l-arginine) (NO) ADMA NO ADMA ADMA NO ADMA [14] NO (troponin CPK) troponin-i troponin-t CPK [15] (PTCA) [16] (ACEI ARB) [17]

5 [18] 65 [19] (ADPKD) (aneurysm) [20] (Ankle-Brachial Index, ABI) ABI ABI 0.9 statin (Aspirin) Cilostazol - (Cardio-renal syndrome) [5] (ACEI ARB) (KDOQI Guidelines) ( 2)

6 2. KDOQI < 130/80 mm Hg (HbA1C) < 7.5% (Hgb) g/dl, 33 36% (LDL) < 100 mg/dl (TG) < 500 mg/dl stage mg/dl stage mg/dl stage 3 4 stage mg/dl < 55 mg 2 /dl 2 (intact PTH) stage 5 < 300 pg/ml 2 National Kidney FoundationKDOQI 1. Culleton BF, Larson MG, Evans JC, et al: Prevalence and correlates of elevated serum creatinine levels: the Framingham Heart Study. Arch Intern Med 1999; 159: Ritz E, McClellan WM: Overview: Increased cardiovascular risk in patients with minor renal dysfunction: An emerging issue with far-reaching consequences. J Am Soc Nephrol 2004; 15: Weiner DE, Tighiouart H, Amin MG et al: Chronic kidney disease as a risk factor for cardiovascular disease and allcause mortality: a pooled analysis of community-based studies. J Am Soc Nephrol 2004; 15: C Zoccali: Traditional and emerging cardiovascular and renal risk factors: An epidemiologic perspective. Kidney Int 2006; 70: Amann K, Wanner C, Ritz E: Cross-talk between the kidney and the cardiovascular system. J Am Soc Nephrol 2006; 17: Ninomiya T, Kiyohara Y, Kubo M et al: Hyperhomocysteinemia and the development of chronic kidney disease in a general population: the Hisayama study. Am J Kidney Dis 2004; 44: Ritz E: The clinical management of hyperphosphatemia. J Nephrol 2005; 218: Cozzolino M, Gallieni M, Brancaccio D: Vascular Calcification in Uremic Conditions: New Insights into Pathogenesis Semin Nephrol 2006; 26: Stenvinkel P, Wang K, Qureshi AR, et al: Low fetuin-a levels are associated with cardiovascular death: Impact of variations in the gene encoding fetuin. Kidney Int 2005; 67: Roberts MA, Hare DL, Ratnaike S, Lerino FL: Cardiovascular biomarkers in CKD: pathophysiology and implications for clinical management of cardiac disease. Am J Kidney Dis 2006; 48: Stenvinkel P, Heimburger O, Paultre F, et al: Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int 1999; 55: Oberg BP, McMenamin E, Lucas FL, et al: Increased prevalence of oxidant stress and inflammation in patients with moderate to severe chronic kidney disease. Kidney Int 2004; 65: De Groot K, Bahlmann FH, Sowa J, et al: Uremia causes endothelial progenitor cell deficiency. Kidney Int 2004; 66: Smith CL, Anthony S, Hubank M, Leiper JM, Vallance P: Effects of ADMA upon gene expression: An insight into the pathophysiological significance of raised plasma ADMA. PLoS Med 2005; 2: e Freda BJ, Tang WHL, Lente FV, Peacock WF, Francis GS: Cardiac troponins in renal insufficiency: Review and clinical implications. J Am Coll Cardiol 2002; 40: Harnett JD, Foley RN, Kent GM, Barre PE, Murray D, Parfrey PS: Congestive heart failure in dialysis patients: prevalence, incidence, prognosis and risk factors. Kidney Int 1995; 47: Wase A, Basit A, Nazir R, et al: Impact of chronic kidney disease upon survival among implantable cardioverterdefibrillator recipients. J Interv Card Electrophysiol 2004; 11: Chen N: The epidemiology survey of cardiovascular disorder in chronic renal failure in Shanghai. Chinese Journal of Nephrology 2001; 17: Abramson JL, Jurkovitz CT, Vaccarino V, Weintraub WS, Mcclellan W: Chronic kidney disease, anemia, and incident stroke in a middle-aged, community-based population: The ARIC study. Kidney Int 2003; 64: Anonymous: A randomised, blinded trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE), CAPRIE steering Committee. Lancet 1996; 348: