Metabolic abnormalities in chronic kidney disease that contribute to  cardiovascular disease, and nutritional initiatives that may  diminish the risk.
OBJECTIVE
Chronic kidney disease (CKD) is associated with a wide range of severe metabolic and nutritional disturbances that directly or indirectly contribute to left ventricular hypertrophy, ischemic heart disease, vascular calcification, heart failure and other manifestations of cardiovascular disease (CVD). The CVD mortality rate in CKD patients is far higher than in the general population, and CKD is today recognized as one of the most important risk factors for CVD. In this review, we discuss the links between metabolic abnormalities and CVD in CKD patients and nutritional initiatives that may reduce this risk.


RESULTS
Certain nontraditional risk factors, such as protein-energy wasting, inflammation, and biomarkers reflecting bone and mineral disorders, are strong predictors of CVD mortality in CKD patients. Although several small nutritional intervention studies have been performed and nutritional guidelines have been introduced in order to minimize metabolic disorders and improve nutritional status, they have so far not been proven to reduce morbidity nor mortality.


CONCLUSIONS
Although the pathophysiological mechanisms involved in the markedly increased CVD risk of CKD patients are becoming more evident, still few nutritional randomized controlled studies have been conducted in this high-risk patient group.
Chmielewski
Michal
M
Department of Clinical Science, Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Stockholm, Sweden.
Carrero
Juan Jesus
JJ
Stenvinkel
Peter
P
Lindholm
Bengt
B
D002318:Cardiovascular Diseases / Q000209:etiology* / Q000378:metabolism*; D002908:Chronic Disease; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000378:metabolism*; D018673:Nutrition Policy; D040242:Risk Reduction Behavior