Renal Disease in Cardiovascular Disorders: An Underrecognized Problem

Abstract

Chronic renal disease is generally appreciated as a major and rapidly growing health problem. In the United States alone, as many as 19.5 million people may have markers of early renal disease, and more than 660,000 people are expected to require renal replacement therapy by the year 2010. By contrast, the presence and pathological role of renal disease in patients with cardiovascular disease are somewhat underrecognized. Evidence now shows that even minor impairments in renal function, as indicated by measures including glomerular filtration rate and microalbuminuria, are common in cardiovascular disease states and predictive of cardiovascular events. Indeed, microalbuminuria may be a marker of systemic vascular disease rather than kidney dysfunction alone. In patients with hypertension, diabetes, metabolic syndrome, acute coronary syndromes, and stroke, markers of renal disease have proved to be at least as predictive of morbidity and mortality as conventional risk factors. Yet, chart reviews in a variety of clinical settings reflect poor recognition and management of renal disease in at-risk patients. Models for renal protection are based on the control of risk factors, particularly blood pressure, that are associated with renal and cardiovascular outcomes. Screening protocols for markers of renal disease should recognize the potential inaccuracy of serum creatinine concentrations and the preferability of glomerular filtration rate estimates that take age and gender into account. Pilot programs for screening high-risk populations have shown efficacy in detecting renal disease.

Chronic kidney disease and risk of death during hospitalization for stroke

“…[8][9][10][11]. Since several routine clinical practice studies suggest that there is inadequate management of CKD in patients hospitalized with a variety of medical conditions, [12] more information on the qualitative and quantitative effects of CKD on hospital outcomes following an index stroke may help identify those patients at high risk for poor outcomes who may benefit from closer surveillance and timely expert input [13].…”

Relation of baseline presence and severity of renal disease to long-term mortality in persons with known stroke

“…However, beyond the link between baseline renal dysfunction and incident vascular disease, mild to moderate CKD has been related to generally poorer clinical outcomes following an index vascular event [4]. Yet, several studies in a variety of clinical settings reflect poor surveillance for, and management of, renal disease in these at-risk patients [5]. Early identification of undiagnosed CKD may facilitate initiation of therapy aimed at limiting further renal function deterioration or optimizing vascular risk reduction, thereby boosting clinical outcomes among persons with established cerebrovascular disease [6].…”

Indices of Kidney Dysfunction and Discharge Outcomes in Hospitalized Stroke Patients without Known Renal Disease

“…However, even persons with mild to moderate CKD tend to have generally poorer clinical outcomes following an index acute cardiovascular event [4]. Yet, data obtained from diverse clinical settings indicate poor surveillance for and management of renal disease in these at-risk patients [5]. …”