Multimodal Detection of Subclinical Cardiovascular Disease in Chronic Kidney Disease

Cardiovascular disease (CVD), the predominant cause of mortality among individuals with chronic kidney disease (CKD), is driven by chronic inflammation and oxidative stress, vascular calcification, accumulation of uremic toxins, ventricular remodeling, and microvascular dysfunction. Subclinical forms of CVD are highly prevalent in CKD and are often unrecognized until advanced stages, contributing to a substantial mortality gap due to delayed intervention. Therefore, screening for subclinical CVD among patients with CKD is important to potentially prevent CVD progression and mitigate downstream events. Advances in imaging-including echocardiography, coronary computed tomography angiography (CCTA), coronary artery calcium (CAC) scoring, and cardiac magnetic resonance imaging (CMR)-now offer sensitive, noninvasive detection of early cardiac and vascular abnormalities in CKD. Circulating and urinary biomarkers such as C-reactive protein (CRP), high-sensitivity troponin (hsT), N-terminal pro brain-type natriuretic peptide (NT-proBNP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), fibroblast growth factor 23 (FGF-23), and urine albumin-to-creatinine ratio (UACR) provide valuable insight into underlying pathophysiological processes, risk stratification, and individualized management in the CKD population. This review summarizes recent progress in the identification of CVD in CKD, with an emphasis on novel imaging strategies, biomarker innovation, and the need for integrative approaches to closing the cardiovascular mortality gap in this vulnerable population.