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Addressing cardiovascular disease in patients with renal disease
Errol D Crook1, David O Washington
1Wayne State University School of Medicine, John D. Dingell VA Medical Center, Detroit, Michigan, USA. ecrook@dmc.org
Insights
Patients with renal disease face a high risk of cardiovascular disease (CVD) death. Aggressive blood pressure control is recommended, alongside lipid management and smoking cessation, to mitigate this risk.
Area of Science:
- Nephrology
- Cardiology
- Public Health
Background:
- Patients with renal disease, including end-stage renal disease (ESRD), have a significantly elevated risk of cardiovascular disease (CVD) mortality.
- Despite improved understanding and guidelines for CVD risk factors in ESRD patients, CVD remains the leading cause of death.
- Increased CVD risk is also observed in individuals with moderate to mild renal dysfunction and albuminuria.
Purpose of the Study:
- To review the evidence for cardiovascular disease (CVD) risk and management strategies in patients with renal dysfunction.
- To highlight the importance of blood pressure control and other risk factor modifications in this high-risk population.
Main Methods:
- Literature review of studies examining cardiovascular disease (CVD) endpoints in patients with renal disease.
- Analysis of current guidelines and recommendations for CVD risk factor management in renal dysfunction.
Main Results:
- Sufficient evidence supports blood pressure reduction for improved CVD morbidity and mortality in renal disease patients, particularly those with diabetes.
- Evidence for other CVD risk factor modifications (lipids, smoking cessation, nutrition) is less robust but recommended.
- Few studies with CVD endpoints have specifically included patients with renal disease.
Conclusions:
- Cardiovascular disease (CVD) remains the primary cause of mortality in end-stage renal disease (ESRD) patients.
- Aggressive blood pressure management is crucial for reducing CVD risk in patients with renal dysfunction.
- Risk stratification and modification strategies should be applied to this high-risk population, necessitating further research including renal patients in CVD outcome studies.
Abstract:
It is well-established that patients with renal disease are at increased risk of cardiovascular disease (CVD) death. Despite better understanding of CVD in endstage renal disease (ESRD) patients and more rigid guidelines addressing the major risk factors for CVD in this population, CVD continues to be the number one cause of death in patients with ESRD. Moreover, higher rates of CVD are seen in patients with moderate, and even mild, renal dysfunction and in patients with albuminuria (micro and macroscopic). Few studies with CVD endpoints have included patients with renal disease. There is sufficient evidence to support appropriate blood pressure reduction as having a beneficial effect on CVD morbidity and mortality in patients with renal disease (especially for patients with diabetes). Data supporting the benefit of modification of other CVD risk factors is not as strong, but current recommendations do stress aggressive control of lipids, smoking cessation, and maintenance of adequate nutritional status. Inclusion of patients with renal disease in studies with CVD endpoints is necessary. Until then, it is generally recommended that CVD risk stratification and modification strategies be applied to this high-risk population.