Cardiovascular Disease in CKD: Ethnic and Regional Differences in Risk and Phenotype

Area of Science:

• Nephrology
• Cardiology
• Epidemiology

Background:

• Cardiovascular disease (CVD) is the primary cause of death in chronic kidney disease (CKD) patients.
• Global variations in CVD burden and outcomes exist among CKD populations.
• Differences attributed to race may reflect underlying cardiometabolic risk, inflammation, environment, and healthcare access.

Purpose of the Study:

• To review global patterns of cardiovascular burden and outcomes in CKD.
• To compare cardiorenal phenotypes across major international CKD cohorts.
• To advocate for phenotype- and exposure-informed cardiovascular risk assessment in CKD.

Main Methods:

• Synthesis of evidence from major international CKD cohorts (CRIC, GCKD, CRISIS, EQUAL, CKD-JAC, C-STRIDE, KNOW-CKD).
• Examination of cardiovascular burden, phenotypes, and clinical outcomes.
• Comparison of findings between North American/European and East Asian cohorts.

Main Results:

• North American/European CKD cohorts exhibit higher inflammatory burden, coronary artery calcification, and left ventricular hypertrophy, leading to a CVD-dominant trajectory.
• East Asian CKD cohorts show fewer atherosclerotic and cardiac structural issues, with a kidney-dominant trajectory.
• Significant global variations in cardiorenal phenotypes are observed.

Conclusions:

• Cardiorenal phenotypes in CKD differ substantially across global populations.
• Moving beyond race-based descriptions to phenotype- and exposure-informed approaches is crucial.
• Integrating imaging, inflammatory biomarkers, and cardiometabolic profiles can enhance precision and equity in CKD cardiovascular prevention.