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Updated: Jun 6, 2026

Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Cardiovascular disease in chronic kidney disease: data from the Kidney Early Evaluation Program (KEEP)
Peter A McCullough1, Susan Steigerwalt, Kirit Tolia
1Department of Medicine, Sections of Cardiology, Nephrology, and Endocrinology, St. John Providence Health System, Providence Park Hospital, Novi, MI, USA. peteramccullough@gmail.com
Insights
Patients with chronic kidney disease (CKD) face higher risks of cardiovascular disease (CVD) and mortality. Targeted interventions are crucial for improving CKD patient risk factor control and reducing CVD events.
Area of Science:
- Nephrology
- Cardiology
- Public Health
Background:
- Diabetes mellitus (DM) and hypertension (HTN) are primary drivers of cardiovascular disease (CVD) and chronic kidney disease (CKD).
- CKD is defined by estimated glomerular filtration rate <60 mL/min/1.73 m² or urine albumin:creatinine ratio ≥30 mg/g.
- CKD is a significant risk factor for CVD, myocardial infarction, stroke, and mortality.
Purpose of the Study:
- To analyze the prevalence of CKD and CVD in the Kidney Early Evaluation Program (KEEP).
- To investigate the association between CKD, CVD, and mortality.
- To evaluate CVD risk factor control in patients with CKD.
Main Methods:
- Analysis of data from the nationwide KEEP cohort.
- Definition of CKD based on established eGFR and albuminuria criteria.
- Assessment of self-reported CVD, myocardial infarction, and stroke prevalence.
Main Results:
- CKD prevalence was 25.7% and self-reported CVD was 22.1% in the KEEP cohort.
- CKD was linked to younger ages at myocardial infarction and stroke.
- Patients with CKD and CVD had shorter survival times.
- Despite some improvements, the majority of CKD patients had uncontrolled blood pressure, glucose, or lipids.
Conclusions:
- Patients with CKD exhibit elevated risks for CVD and mortality.
- CKD patients are prime candidates for targeted interventions to improve risk factor management.
- Community and practice-based interventions can potentially reduce cardiovascular events in CKD populations.
Abstract:
Diabetes mellitus (DM) and hypertension (HTN) are leading joint risk factors for both cardiovascular disease (CVD) and chronic kidney disease (CKD). In the nationwide KEEP (Kidney Early Evaluation Program) an estimated glomerular filtration rate less than 60 mL/min/1.73 m(2) or a urine albumin:creatinine ratio ≥30 mg/g (3.4 mg/mmol) defines CKD. Overall in KEEP, the rates of identified CKD and self-reported CVD are 25.7% and 22.1%, respectively. The presence of CKD has been associated with younger ages of self-reported myocardial infarction and stroke. The combination of CVD and CKD in KEEP has been associated with shorter survival time. Finally, the presence of CVD or a prior history of coronary revascularization has been associated with modestly better rates of CVD risk factor control; however, the majority of patients with CKD have suboptimally controlled blood pressure, glucose, or lipids. These data suggest that patients with CKD are not only at higher risk for CVD and subsequent mortality, but are also ideal for targeted community--and practice-based interventions to improve risk factor control and, hopefully, reduce rates of subsequent cardiovacular events.
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