Epidemiology of cardiovascular risk in chronic kidney disease patients: the real silent killer

Abstract

This is an open access article under the CC BY-NC 4.0 license (https://creativecommons.org/licenses/by-nc/4.0/). Chronic kidney disease is a growing public health problem, as its prevalence and incidence have almost doubled over the last three decades. Chronic kidney disease is defined as the presence of an estimated glomerular filtration rate < 60 ml/min/1.73 m 2 and/or proteinuria ≥ 0.150 g/24 h. It has been demonstrated that both proteinuria and reduction in estimated glomerular filtration rate can predict the development of fatal and nonfatal cardiovascular events, regardless of traditional cardiovascular risk factors, namely blood pressure, smoking habit, cholesterol, age, gender. This relationship is found in the general population, high-risk cohorts and in patients referred to Nephrologists (tertiary care). The accuracy by which proteinuria or estimated glomerular filtration rate can predict these events, exceeds that obtained by the combination of all the other traditional risk factors. These important findings have led to chronic kidney disease being considered as a cardiovascular risk equivalent. Although this needs further investigation, a great effort has been made to reduce the cardiovascular risk in chronic kidney disease patients. Indeed, many clinical trials have been carried-out testing the effect of antihypertensive, proteinuria-lowering, lipid-lowering and hypoglycemic agents on cardiovascular risk protection. All these trials reduced, but did not eliminate, the overall cardiovascular risk. Future studies should be undertaken to identify high cardiovascular risk patients and novel therapeutic targets for cardiovascular protection in chronic kidney disease patients.

Risk factors for acute kidney injury and mortality in high risk patients undergoing cardiac surgery

“…In addition, more than 30% of patients developed AKI or died during follow-up. It has been widely demonstrated that cardiovascular disease is strictly linked to kidney impairment, since an acute or chronic disorder in one organ may induce an acute or chronic disorder in another one [ 25 , 26 ]. The presence of cardiac dysfunction leads to the activation of the renin-angiotensin-aldosterone-system (RAAS), sympathetic nervous system and vasopressin secretion, leading to fluid retention [ 27 ].…”

Effects of Sacubitril-Valsartan in Heart Failure With Preserved Ejection Fraction in Patients Undergoing Peritoneal Dialysis

“…Diagnosis of HFpEF was challenging and required assessment of clinical history, physical examination, natriuretic peptide testing, echocardiography data, and invasive exercise testing (21). Recently, the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) produced an updated consensus recommendation-the HFA-PEFF diagnostic algorithm including clinical assessments (HF symptoms and signs), diagnostic laboratory tests (including NT-proBNP values), and standard echocardiography (22). Notably, a combination of echocardiographic measurements of cardiac structure and function and BNP levels were recommended.…”

Aortic Aneurysms, Chronic Kidney Disease and Metalloproteinases

“…Chronic Kidney Disease is defined as the presence, for at least 3 months, of abnormalities across the urinary system and/or out-of-range levels of two kidney measures, namely, estimated Glomerular Filtration Rate (eGFR) and proteinuria [10]. It has been shown that both low eGFR and high proteinuria levels forecast cardiovascular events, including peripheral vascular disease [11,12]. More specifically, both the two kidney measures, eGFR and proteinuria, have been independently associated with an increased risk for incident abdominal AA as well as with an increase in diameter of the abdominal aorta [9].…”