Cardiovascular co-morbidity in chronic kidney disease: Current knowledge and future research needs

Abstract

Chronic kidney disease (CKD) is recognised as a health concern globally and leads to high rates of morbidity, mortality and healthcare expenditure. CKD is itself an independent risk factor for unfavorable health outcomes that include cardiovascular disease (CVD). Coronary artery disease is the primary type of CVD in CKD patients and a significant cause of death among renal transplant patients. Traditional and non-traditional risk factors for CVD exist in patients with CKD. Traditional factors include smoking, hypertension, dyslipidemia and diabetes which are highly prevalent in CKD patients. Non-traditional risk factors of CKD are mainly uraemiaspecific and increase in prevalence as kidney function declines. Some examples of uraemia-specific risk factors that have been well documented include low levels of haemoglobin, albuminuria, and abnormal bone and mineral metabolism. Therapeutic interventions targeted at more traditional risk factors which contribute to CVD, have not had the desired effect on lowering CVD events and mortality in those suffering with CKD. Future research is warranted to delineate clear evidence to the benefit of modifying non-traditional risk factors. Key words: Cardiovascular disease; Chronic kidney disease; Risk factors; InflammationCore tip: Chronic kidney disease (CKD) has been recognised as a health concern globally and leads to high morbidity, mortality and healthcare expenditure. CKD is an independent risk factor for several different unfavourable outcomes including cardiovascular disease (CVD). Traditional and non-traditional risk factors for CVD exist in patients with CKD. Non-traditional risk factors of CKD are mainly uraemia-specific and include release of large levels of inflammatory and prothrombotic factors, low levels of haemoglobin, albuminuria, and abnormal bone and mineral metabolism. Future research is warranted to delineate clear evidence to the benefit of modifying non-traditional risk factors Alani H, Tamimi A, Tamimi N. Cardiovascular co-morbidity in chronic kidney disease: Current knowledge and future research needs. World J Nephrol 2014; 3(4): 156-168 Available from:

Prevalence of anemia and cardiovascular diseases in chronic kidney disease patients: a single tertiary care centre study

“…1 CKD has become recognized as a key independent risk factor for several adverse health outcomes including cardiovascular disease (CVD) so much so that many studies have shown that CKD patients are more likely to die from cardiovascular disease than to develop end stage renal disease (ESRD). 2 Anaemia is an anticipated consequence as renal function declines, and generally begins to develop before ESRD. The severity of anemia increases with declining kidney function.…”

“…Specifically to LVH development and is an independent predictor of consequent cardiac morbidity and mortality among patients with ESRD. 2 Here we have attempted to study the prevalence of anemia and cardiovascular diseases in CKD patients and establish an association between them.…”

“…1 Individuals with CKD are usually staged according to their GFR levels (Stage 1-5) and albuminuria category, with a higher stage representing lower GFR levels1. GFR category is assigned as G1 (>90 ml/min/1.73 m 2 ), G2 (60-89 ml/min/1.73 m 2 ), G3a (45-59 ml/min/1.73 m 2 ), G3b (30-44 ml/min/1.73 m 2 ), G4 (15-29 ml/min/1.73 m 2 ) and G5 (<15 ml/min/1.73 m 2 ). Albuminuria categories are A1 (<30 mg/24 hours), A2 (30-300 mg/24 hours) and A3 (>300 mg/24 hours).…”

Opinion on Primary and Secondary Prevention of Chronic Kidney Disease

“…The potential risks associated with CVD can be termed as traditional (smoking, hypertension, dyslipidemia and diabetes) or non-traditional risk factors (uremia-specific and consist of the escape of enormous levels of inflammatory and prothrombotic factors, low levels of hemoglobin, albuminuria, and abnormal bone and mineral metabolism [5]. Researchers have estimated that 50% of individuals diagnosed with ESRD will improbably not out live a CVD event; in comparison to the overall society.…”

“…Other professional entities including the NKF, the Renal Physicians Association, and The American Diabetes Association (ADA) validate the need to provide CKD screening to those individuals classified as at-risk. The CKD guidelines established by the Kidney Disease Improving Global Outcomes (KDIGO) failed to acknowledge screening for CKD (5 …”