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Chronic lower limb ischemia diminishes the quality of life and is associated with a higher risk of limb amputation and cardiovascular mortality. Coexisting chronic renal disease can modulate the response to pharmacotherapy and revascularization, and thus influence prognosis. This paper reviews current literary evidence regarding therapeutic problems observed in patients with obliterative atherosclerosis and renal failure. We reviewed articles from peer-reviewed medical journals which were published between 2000 and 2011. The poorer clinical response in the discussed patients is not only connected with the direct failure of surgical and endovascular procedures, but first of all with the high mortality of the patients. There is still a lack of sufficient evidence on the effectiveness of currently used anti-atherosclerotic agents in patients with end-stage renal failure. A certain priority is the search for an effective therapeutic strategy that would reduce mortality associated with cardiovascular conditions in this particular group of patients. Identifying patients who can benefit most from costly endovascular procedures is another vital issue.

Deoxyribonuclease (DNase) activity and metal ion concentrations in lymphocytes of patients with chronic renal failure and in healthy controls were studied. The data suggest that T and B lymphocyte nuclei of patients with renal failure show increased DNase activity when compared to their healthy counterparts. It is suggested that the enhancement of enzyme activity is a result of increased metal ion concentration rather than increased enzyme copy count. The data strongly suggest that haemodialysis of uraemic patients is more effective for improvement of lymphocyte metabolism than the conservative chemical treatment.

On the basis of a retrospective assessment of aluminium content in the bones and morphometric findings in spongy bones of patients maintained on long-term dialyses a trial was undertaken of demonstration of a possible causative effect of this metal on the development of osteomalacia. The analysis included also the role of aluminium in the development of intravitally occurring fractures of bones in these patients. A biopsy specimen was taken from the iliac ala with a modified Bartelheimer's needle. The study comprised two groups of patients. The first one included 10 patients in a mean age of 38.2 +/- 6.6 years remaining, on the average, since 72.3 +/- 33.6 month who had previously evidence of fractures demonstrated clinically and radiologically. In the second group 12 patients of a mean age of, 41.9 +/- 6.8 years on dialyses since 40.3 +/- 12.2 months with demonstrated subperiosteal resorption, and patients with normal radiological appearance of the skeleton were studied. The patients were dialysed using a dialysate prepared from water not previously adapted and containing Al in a concentration of 0.135 +/- 0.102 mg/l. The diagnosis of osteomalacia was based on the morphometric method of Bordier (6). In both studied groups a highly significant rise was demonstrated in the concentration of Al in the spongy bone, and pathological fractures were closely related to the morphometric markers of osteomalacia. Aluminium cumulation in the bone tissue of patients with fractures exerted a significant effect on an increase of osteoid volume and reduction of mineralization fronts, and demonstrated a directly proportional relationship with the time of treatment with dialyses and overall exposure to aluminium in the dialysing fluid. In the group with osteomalacia a linear trend was observed in the increase of osteoid volume related to aluminium retention in spongy bone.

In 19 patients aged 19 to 45 years on long-term dialysis treatment during 12.6 +/- 18.2 months the concentrations of Rb and Cs were determined by atomic spectrometry in whole blood before and behind the dialyser at the beginning and end of dialysis. At the same time the concentrations of these elements were determined in the dialysing fluid. In all patients the velocity of conduction in the motor fibres in the upper and lower extremities was determined before and after dialysis. Damage to the peripheral neurons was demonstrated in the lower extremities mainly in 79% of cases. Increased velocity of motor conduction in at least one nerve related directly proportionally to the Cs concentration of the serum was demonstrated in 56-70% of the patients after one dialysis.