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Primary renal disease as a cardiovascular risk factor
Errol D Crook1, John M Flack, Mahmoud Salem
1Department of Medicine, University of Mississippi Medical Center, Jackson, USA. ecrook@dmc.org
Insights
Cardiovascular disease (CVD) is the leading cause of death for end-stage renal disease (ESRD) patients. Screening for kidney disease in those with hypertension or diabetes can predict major CVD events.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Cardiovascular disease (CVD) is the primary cause of mortality in end-stage renal disease (ESRD) patients, occurring 3-5 times more frequently than in non-uremic individuals.
- Elevated CVD risk is observed even with mild to moderate renal dysfunction, especially in patients with hypertension or diabetes.
- Increased CVD risk is linked to modest elevations in serum creatinine and urinary albumin excretion in the general population, not just those with diabetes or hypertension.
Purpose of the Study:
- To highlight the significant link between renal dysfunction and cardiovascular disease risk.
- To emphasize the predictive value of renal disease screening in individuals with common cardiovascular risk factors.
- To discuss the therapeutic implications of targeting the kidney in managing hypertension, diabetes, and heart failure.
Main Methods:
- Review of recent studies and clinical observations linking renal function markers to cardiovascular outcomes.
- Analysis of epidemiological data on CVD mortality in ESRD patients.
- Examination of the role of the renin-angiotensin-aldosterone-kinin system in renal and cardiovascular protection.
Main Results:
- Cardiovascular disease is the predominant cause of death in ESRD.
- Mild to moderate renal dysfunction, indicated by serum creatinine and urinary albumin, is associated with increased CVD risk across populations.
- Interventions targeting the kidney can slow renal disease progression and reduce vascular complications.
Conclusions:
- Screening for renal disease is crucial for individuals with hypertension, diabetes, and other CVD risk factors.
- Identifying renal dysfunction aids in predicting high-risk patients for major cardiovascular events.
- Early detection and management of kidney disease are vital for mitigating cardiovascular mortality in at-risk populations.
Abstract:
Cardiovascular disease (CVD) is the No. 1 cause of death in patients with end-stage renal disease (ESRD) and is approximately 3 to 5 times that of non-uremic control subjects. Moreover, higher rates of CVD are seen in patients with moderate and even mild renal dysfunction, particularly if the patient has hypertension or diabetes. Recent studies have indicated that even modest elevations in serum creatinine and urinary albumin excretion are associated with increased CVD risk, not only in persons with diabetes or hypertension but also in the general population. In addition, recent studies have suggested that targeting the kidney and/or kidney specific endpoints (via the renin-angiotensin-aldosterone-kinin system) in the treatment of hypertension, diabetes, and heart failure slows progression of renal disease and reduces the risk of extra-renal micro- and macrovascular complications. We conclude that it is important to screen for renal disease in those with hypertension, diabetes, and other CVD risk factors because it predicts those who are at high risk for major CVD events.