Cardiorenal connection in chronic kidney disease
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1Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan. ishisho@med.tohoku.ac.jp
Insights
Chronic kidney disease (CKD) significantly increases cardiovascular event risk, independent of traditional factors. Microalbuminuria, a CKD marker, is a key risk factor, potentially linked through the renin-angiotensin system (RAS).
Area of Science:
- Nephrology
- Cardiology
- Public Health
Background:
- Chronic kidney disease (CKD) is a growing public health concern, defined by reduced kidney function or damage.
- CKD independently elevates cardiovascular event risk beyond established factors like hypertension and diabetes.
- Microalbuminuria, a marker of kidney damage, is a significant cardiovascular risk factor in various populations.
Purpose of the Study:
- To investigate the mechanisms linking CKD to cardiovascular events.
- To explore the role of microalbuminuria and salt sensitivity in this association.
- To discuss the 'strain vessel hypothesis' and the impact of underlying diseases and RAS inhibition.
Main Methods:
- Review of epidemiological studies and current research on CKD and cardiovascular risk.
- Analysis of potential mechanisms including the renin-angiotensin system (RAS), oxidative stress, and inflammation.
- Discussion of hemodynamic factors and the 'strain vessel hypothesis' for cerebrocardiorenal connections.
Main Results:
- CKD is an independent risk factor for cardiovascular events.
- Microalbuminuria is a significant predictor of cardiovascular disease, even in normotensive individuals.
- Salt sensitivity is closely associated with microalbuminuria and cardiovascular risk.
Conclusions:
- CKD poses a substantial threat to cardiovascular health through various interconnected mechanisms.
- Understanding these links, including the 'strain vessel hypothesis', is crucial for patient management.
- RAS inhibition may play a role in managing cardiovascular risks in CKD patients.
Abstract:
Chronic kidney disease (CKD), as defined by reduced glomerular filtration rate (<60 ml/min/1.73 m(2)) and/or the presence of renal damage for >3 months, is a significant threat for public health in modern societies. Recent epidemiological studies have demonstrated that CKD is a significant risk for cardiovascular events independently of classical risk factors such as hypertension, dyslipidemia and diabetes. The mechanisms by which CKD increases the risk of cardiovascular events are currently under intensive investigation. Among various components of CKD, microalbuminuria is of particular interest, because it is a significant risk factor not only in diabetic and hypertensive subjects but also in the general population. Microalbuminuria is also closely associated with salt sensitivity of blood pressure, and the salt sensitivity is an independent risk factor for cardiovascular disease even in normotensive subjects. Several factors are likely to be involved in such associations, including the renin-angiotensin system (RAS), oxidative stress and inflammation. In addition, there may be more specific hemodynamic mechanisms in the kidney and other vital organs underlying these associations. This review describes 'the strain vessel hypothesis' as a possible mechanism for cerebrocardiorenal connections. In addition we discuss the significance of underlying diseases as cardiovascular risks of CKD as well as the role of RAS inhibition in the management of CKD patients.
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