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Noncardiovascular mortality in CKD: an epidemiological perspective
Dinanda J de Jager1, Marc G Vervloet2, Friedo W Dekker1
1Department of Clinical Epidemiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, Netherlands.
Insights
Patients with chronic kidney disease (CKD) face higher mortality risks. This review examines both cardiovascular and noncardiovascular causes of death in CKD patients, highlighting shared risk factors and mechanisms.
Area of Science:
- Nephrology
- Cardiology
- Public Health
Background:
- Patients with chronic kidney disease (CKD) exhibit elevated all-cause mortality.
- Cardiovascular mortality is well-documented in end-stage renal disease (ESRD).
- Noncardiovascular mortality in CKD is increasingly recognized as a significant concern.
Purpose of the Study:
- To discuss cardiovascular and noncardiovascular mortality in CKD.
- To detail noncardiovascular causes of death in CKD patients.
- To explore shared risk factors and pathophysiological mechanisms.
Main Methods:
- Review of existing literature on mortality in CKD.
- Analysis of studies detailing noncardiovascular causes of death.
- Examination of risk factors associated with both cardiovascular and noncardiovascular mortality.
Main Results:
- Several factors, including fetuin-A, troponin T, C-reactive protein, vitamin D deficiency, and proteinuria, are linked to both cardiovascular and noncardiovascular mortality.
- Inflammatory reactions and the uraemic milieu are potential pathophysiological mechanisms.
- CKD is associated with increased risks for both cardiovascular and noncardiovascular death.
Conclusions:
- Future research must address both cardiovascular and noncardiovascular mortality in CKD.
- Investigating the interplay between causal pathways for cardiovascular and noncardiovascular mortality is crucial.
- A comprehensive approach is needed to reduce overall mortality in CKD patients.
Abstract:
Patients with chronic kidney disease (CKD) have increased risk of all-cause mortality; the elevated cardiovascular mortality in patients with end-stage renal disease is particularly well documented. Lately, the increased noncardiovascular mortality in these patients has gained particular attention. In this article, both cardiovascular and noncardiovascular mortality in CKD are discussed, with specific attention paid to studies that provide details of noncardiovascular causes of death. Examples are provided of several cardiovascular risk factors that also seem to be associated with noncardiovascular mortality, including levels of fetuin-A, troponin T, and C-reactive protein, as well as vitamin D deficiency and proteinuria. Potential pathophysiological mechanisms (such as inflammatory reactions and the uraemic milieu) that might explain the increased cardiovascular and noncardiovascular mortality in CKD are also discussed. Future research should not only focus on preventing cardiovascular mortality, but also on studying noncardiovascular mortality and the potential link between causal pathways of cardiovascular mortality and noncardiovascular mortality in CKD.
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