Cardiovascular disease in chronic kidney disease: untying the Gordian knot

Area of Science:

• Nephrology and Cardiology
• Understanding the complex interplay between kidney function and cardiovascular health.

Background:

• Chronic kidney disease (CKD) impacts 10-13% of the global population.
• CKD patients face a substantially higher risk of cardiovascular disease (CVD) compared to the general population.
• CVD progression in CKD patients often occurs before reaching end-stage renal disease (ESRD).

Purpose of the Study:

• To elucidate the pathophysiological mechanisms linking CKD and CVD.
• To review existing interventional strategies for managing CVD in CKD patients.
• To highlight the current scarcity of randomized controlled trial (RCT) evidence in this field.

Main Methods:

• Comprehensive literature review focusing on the relationship between CKD and CVD.
• Analysis of proposed pathophysiological pathways including endothelial dysfunction, dyslipidemia, inflammation, left ventricular hypertrophy, and cardiac autonomic dysfunction.
• Identification of potential interventional strategies and interim measures.

Main Results:

• CKD is a major independent risk factor for CVD.
• Multiple mechanisms contribute to the elevated CVD risk in CKD.
• There is a significant lack of high-quality RCT evidence to guide interventions.

Conclusions:

• The link between CKD and CVD is robust and multifactorial.
• Pragmatic interim measures are necessary while awaiting definitive RCTs.
• Further research, particularly RCTs, is crucial for evidence-based management of CVD in CKD.