Detection of Atherosclerotic Cardiovascular Disease in Patients with Advanced Chronic Kidney Disease in the Cardiology and Nephrology Communities

Abstract

Background: Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality among patients with chronic kidney disease (CKD) with a glomerular filtration rate of < 60 mL/min/1.73 m² body surface area. The availability of high-quality randomized controlled trial data to guide management for the population with CKD and ASCVD is limited. Understanding current practice patterns among providers caring for individuals with CKD and CVD is important in guiding future trial questions. Methods: A qualitative survey study was performed. An electronic survey regarding the diagnosis and management of CVD in patients with CKD was conducted using a convenience sample of 450 practicing nephrology and cardiology providers. The survey was administered using Qualtrics® (https://www.qualtrics.com). Results: There were a total of 113 responses, 81 of which were complete responses. More than 90% of the respondents acknowledged the importance of CVD as a cause of morbidity and mortality in patients with CKD. Outside the kidney transplant evaluation setting, 5% of the respondents would screen an asymptomatic patient with advanced CKD for ASCVD. Outside the kidney transplant evaluation scenario, the respondents did not opt for invasive management strategies in advanced CKD. Conclusions: The survey results reveal a lack of consensus among providers caring for patients with advanced CKD about the management of ASCVD in this setting. Future randomized controlled trials will be needed to better inform the clinical management of ASCVD in these patients. The limitations of the study include its small sample size and the relatively low response rate among the respondents.

Cardiovascular disease in the kidney transplant recipient: epidemiology, diagnosis and management strategies

“…KT recipients continue to be undertreated with regards to cardiovascular risk factor management despite the well-known burden of CVD [132]. In addition, cardiovascular care is fragmented across the continuum of CKD, dialysis and transplantation, with shifting clinical care teams, variable screening protocols and lack of consensus on optimal management of CVD pre-and post-KT [133] (Figure 4). To this end, encouraging participation of KT recipients in cardiovascular trials will facilitate a better understanding of the nuances of CVD management in this unique population based on high-quality data.…”

Klotho alleviates indoxyl sulfate-induced heart failure and kidney damage by promoting M2 macrophage polarization

“…AKI is characterized by an abrupt decline in renal function [4]. Cardiovascular disease (CVD) is a serious complication in patients with CKD and AKI, and is the main cause of death among patients on dialysis [5][6][7]. Reduced GFR has been correlated with an increased risk of CVD among CKD patients [8,9].…”