Chronic kidney disease and its adverse cardiovascular associations

Amongst patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD), the leading cause of recurrent hospitalizations and death is cardiovascular diseases. Patients with CKD are more likely to die from cardiovascular causes than due to kidney related manifestations. Irrespective of the baseline renal function, even overt proteinuria and microalbuminuria are independent predictors of cardiovascular morbidity and mortality. Most current guidelines hence recommend that patients with CKD be considered to belong to the highest risk group for the development of cardiovascular diseases.

However there is a significant “therapeutic inertia” and consequent sub-optimal management of patients with ESRD and associated cardiovascular diseases, owing to the fact that many such patients are often excluded in most large trials of cardiovascular morbidity and mortality. Moreover, due to the high incidence of associated coronary artery disease in patients with ESRD, it is important to appropriately risk stratify such patients awaiting renal transplantation. Though optimal screening protocols and frequency of testing have not been well defined, this paper discusses guidelines based practical approaches to cardiovascular risk in these high-risk patients.