Chronic Kidney Disease and Cerebrovascular Disease: Consensus and Guidance From a KDIGO Controversies Conference

Area of Science:

• Nephrology
• Neurology
• Cardiovascular Medicine

Background:

• Chronic kidney disease (CKD) is a growing global health concern.
• CKD is a significant, independent risk factor for cerebrovascular disease (CVD).
• The interplay between CKD and CVD complicates risk prediction, diagnosis, and management.

Purpose of the Study:

• To summarize the epidemiology, pathophysiology, diagnosis, and treatment of CVD in CKD patients.
• To identify knowledge gaps, controversies, and research priorities.
• To provide a focused review from the KDIGO Controversies Conference on arterial disease.

Main Methods:

• Literature review and expert consensus synthesis.
• Focus on central and peripheral arterial disease in the context of CKD.
• Analysis of shared traditional risk factors (hypertension, diabetes) and nontraditional factors (uremia, oxidative stress, mineral metabolism).

Main Results:

• CKD is associated with increased stroke severity, poorer outcomes, and a high prevalence of silent CVD and vascular cognitive impairment.
• Mechanisms include shared risk factors, uremia-related issues, and dialysis-specific complications.
• Current stroke risk prediction models are often inadequate for CKD populations.

Conclusions:

• Cerebrovascular disease poses a substantial challenge in patients with chronic kidney disease.
• Further research is crucial to address knowledge gaps and improve patient outcomes.
• Multifaceted approaches are needed to manage CVD risk in the CKD population.