Cardiac disease in chronic kidney disease: current understandings and opportunities for change.
Cardiovascular disease (CVD) is prevalent in patients with kidney disease: in populations prior to dialysis, on dialysis and after transplantation. Publications over the last decade have focused on this, and more recently, patients with cardiac disease are now recognized as being at increased risk in the presence of even mild kidney dysfunction. The presence of both traditional and non-traditional risk factors contributes to this overwhelming burden of cardiovascular disease in patients with chronic kidney disease (CKD). Recent studies have focused on the impact of anemia and disorders of mineral metabolism on CVD outcomes, in the context of inflammation and evidence of cytokine activation. Cross-sectional and prospective observational studies have led to improved understanding, and generated novel hypotheses. To date, no clinical trial has determined the positive impact of interventions targeted at these novel risk factors. This overview describes the current state of knowledge and emphasizes the interplay between CVD and CKD as two aspects of a set of pathophysiological processes, which impact on patient outcomes.
Levin
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St Paul's Hospital, University of British Columbia, Vancouver, Canada. alevin@providencehealth.bc.ca
D000740:Anemia / Q000453:epidemiology; D001161:Arteriosclerosis / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D002986:Clinical Trials as Topic; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D042783:Endothelial Cells / Q000473:pathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D008903:Minerals / Q000378:metabolism; D015337:Multicenter Studies as Topic; D017063:Outcome Assessment, Health Care; D012307:Risk Factors
D008903:Minerals