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Updated: May 14, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Coronary Artery-Specific Changes in Patients with Chronic Kidney Disease
Julia Hanke1, Katarzyna Romejko1, Stanisław Niemczyk1
1Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine-National Research Institute, 128 Szaserów Street, 04-141 Warsaw, Poland.
Insights
Chronic kidney disease (CKD) accelerates coronary artery disease through inflammation and calcification, affecting both large vessels and small vessels. Early CKD-specific interventions are crucial for cardiovascular risk prevention.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Pathology
Background:
- Cardiovascular disease (CVD) is the leading cause of death in chronic kidney disease (CKD) patients.
- Coronary artery pathology in CKD differs significantly from traditional atherosclerosis.
- CKD creates a unique environment promoting vascular damage.
Purpose of the Study:
- To review coronary artery alterations specific to CKD.
- To explore mechanisms driving atherogenesis, plaque characteristics, calcification, and microvascular dysfunction in CKD.
- To highlight the distinct nature of CVD in CKD.
Main Methods:
- Literature review focusing on coronary artery pathology in CKD.
- Analysis of mechanisms promoting inflammation, oxidative stress, and calcification.
- Examination of plaque composition, calcific remodeling, and microvascular function.
Main Results:
- CKD promotes a pro-inflammatory, pro-oxidative, and pro-calcific milieu, leading to endothelial damage and vascular calcification.
- Coronary plaques in CKD feature larger lipid cores, increased inflammation, significant calcification, and vulnerability.
- Coronary microvascular dysfunction is common in CKD, contributing to ischemia.
Conclusions:
- CKD is associated with a distinct, accelerated form of coronary artery disease driven by calcification and inflammation.
- This CKD-specific CVD involves both macrovascular plaque changes and microvascular dysfunction.
- Targeting CKD-specific mechanisms alongside conventional risk factors is essential for CVD prevention in these patients.
Abstract:
Cardiovascular disease represents the primary cause of morbidity and mortality among patients with chronic kidney disease (CKD). Emerging evidence suggests that coronary artery pathology in CKD diverges from the traditional atherosclerotic phenotype seen in individuals with maintained renal function. This review delineates coronary artery-specific alterations in CKD, focusing on mechanisms that expedite atherogenesis, characteristics of plaques, calcific remodeling, and dysfunction of the coronary microvasculature. CKD fosters a pro-inflammatory, pro-oxidative, and pro-calcific environment, which results in endothelial damage and vascular calcification remodeling. Furthermore, coronary plaques in CKD are more likely to exhibit larger lipid-rich necrotic cores, heightened inflammatory cell infiltration, a significant calcific burden, and vulnerability indicators such as cholesterol crystals and microdisruptions. Impaired coronary microvascular function is also prevalent and may account for ischemia with non-obstructive coronary arteries. In summary, CKD is linked to a rapid, calcification- and inflammation-driven form of coronary disease characterized by both macrovascular plaque remodeling and microvascular dysfunction. This underscores the necessity of early identification and prevention of cardiovascular risk, targeting CKD-specific mechanisms in conjunction with conventional risk factors.
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