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

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with CKD. Although the association between CKD and CVD is well established, the overall CVD burden, dominant cardiovascular phenotypes, and clinical outcomes vary substantially across populations. These differences are often described using racial or ethnic categories, yet emerging evidence suggests that they more closely reflect variation in cardiometabolic risk, inflammatory burden, environmental exposures, and health care access than race itself. This review synthesizes evidence from major CKD cohorts, including Chronic Renal Insufficiency Cohort (United States), German CKD, Chronic Renal Insufficiency Standards Implementation Study, and European Quality Study (Europe) and CKD Japan Cohort (Japan), Chinese Cohort Study of CKD (China), and KoreaN Cohort Study for Outcomes in Patients With CKD (Korea), to examine global patterns of cardiovascular burden and outcomes in CKD. North American and European CKD cohorts are characterized by greater inflammatory burden, more severe coronary artery calcification, and more pronounced left ventricular hypertrophy, corresponding to a clinical trajectory more heavily dominated by cardiovascular events and mortality. By contrast, East Asian cohorts show fewer overt atherosclerotic and cardiac structural abnormalities and a more kidney-dominant trajectory, in which kidney outcomes are more prominent relative to cardiovascular events. Genetic, environmental, and lifestyle-related modifiers likely contribute to these divergent cardiorenal phenotypes. Collectively, current evidence supports moving beyond race-based descriptions toward phenotype-informed and exposure-informed approaches to cardiovascular risk assessment in CKD, in which integration of imaging markers, inflammatory biomarkers, and cardiometabolic profiles may improve the precision and equity of cardiovascular prevention strategies across diverse CKD populations.