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Cardiovascular disease and the kidney. Tracking a killer in chronic kidney disease
Adeera Levin1, Lesley Stevens, Peter A McCullough
1Division of Nephrology, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada. alevin@providencehealth.bc.ca
Insights
Cardiovascular disease (CVD) and chronic kidney disease (CKD) are closely linked, significantly increasing mortality risk. Early identification of CKD and proactive management of CVD risk factors are crucial for better patient outcomes.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in patients with chronic kidney disease (CKD), including those on renal replacement therapy and with milder forms of kidney disease.
- The high prevalence of CVD in CKD patients necessitates focused strategies to mitigate associated risks.
Purpose of the Study:
- To emphasize the critical need for primary care physicians to identify patients with CKD.
- To outline essential strategies for reducing CVD prevalence in the CKD population.
Main Methods:
- Screening for CKD using serum creatinine, urine microalbumin, and estimated glomerular filtration rate (eGFR).
- Rigorous assessment of conventional CVD risk factors: dyslipidemia, hypertension, and diabetes.
- Screening and treatment for CKD-specific risk factors: anemia, hyperphosphatemia, and hyperparathyroidism.
Main Results:
- Routine use of ACE inhibitors and aspirin is recommended for all CKD patients.
- Strict glycemic and blood pressure control are vital for optimal outcomes.
- Patients with CKD, especially those at high risk for CVD, benefit significantly from cardiovascular therapies.
Conclusions:
- Vigilant identification of CKD and proactive management of associated CVD risks are essential.
- Comprehensive screening and treatment of both conventional and CKD-specific risk factors improve patient prognosis.
- Avoiding therapeutic nihilism and applying cardiovascular therapies to high-risk CKD patients can yield substantial benefits.
Abstract:
The interlinking of CVD with CKD is undeniable. CVD accounts for more than 50% of all morbidity and mortality in patients with kidney disease who have undergone renal replacement therapy, and CVD is also prevalent in patients with mild and moderately severe kidney disease. To help address the elevated risks of these patients, primary care physicians need to maintain vigilance in (1) identifying patients who have CKD and (2) implementing strategies for reducing the prevalence of CVD in this population. It is essential that patients be screened for relatively mild kidney disease by measurement of serum creatinine and urine microalbumin and by calculation of the glomerular filtration rate in mL/min/1.73 m2 using equations based on serum creatinine. Rigorous assessment of conventional risk factors, including dyslipidemia, hypertension, and diabetes, is also necessary to prevent the poor outcomes currently observed in persons with CKD. Routine use of ACE inhibitors and aspirin is encouraged in all patients with CKD, and strict glycemic and blood pressure control is recommended for optimal outcomes. In addition, patients should be screened and treated for risk factors particularly associated with kidney disease and CVD morbidity and mortality, including anemia, hyperphosphatemia, and hyperparathyroidism. Finally, physicians should be careful to avoid therapeutic nihilism in patients with kidney disease; those at highest risk of CVD are likely to receive the greatest benefit from cardiovascular therapies.