Cardiorenal interaction: appropriate treatment of cardiovascular risk factors to improve outcomes in chronic kidney disease.
Chronic kidney disease (CKD) is a recognized risk multiplier for the development of cardiovascular disease (CVD), with CVD events representing the leading cause of morbidity and mortality in patients with CKD. The nature of CKD as a risk state relates both to the nature of CKD and the antecedent development of CVD. In addition, patients with CKD have increased rates of multiple conventional cardiac risk factors. Although early data regarding the relationship between CVD and CKD were limited because of the need for large data sets and multivariable analysis, the importance of recognizing this complex relationship is now clear. The essence of the relationship appears to be bidirectional, and therapy directed at improving natural history of chronic disease on one system generally improves prognosis in the other. Specifically, CVD outcomes have been shown to improve with the treatment of risk factors commonly found in association with CKD, including hypertension, diabetes, dyslipidemia, albuminuria, and smoking, as well as appropriate renin-angiotensin-aldosterone system blockade and antiplatelet therapy. Once hospitalized, management of acute coronary syndromes represents a key area of clinical investigation. The goal of this article is to highlight the importance of these topics in improving cardiovascular outcomes and use of appropriate treatment in CKD.
McCullough
Peter A
PA
Department of Medicine, William Beaumont Hospital, Royal Oak, MI 48073, USA. peteramccullough@gmail.com
Verrill
Thomas A
TA
D054058:Acute Coronary Syndrome / Q000628:therapy; D000419:Albuminuria / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D008076:Cholesterol, HDL / Q000187:drug effects; D008078:Cholesterol, LDL / Q000187:drug effects; D003920:Diabetes Mellitus / Q000628:therapy; D050171:Dyslipidemias / Q000150:complications / Q000188:drug therapy; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D008019:Life Style; D015999:Multivariate Analysis; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D012084:Renin-Angiotensin System / Q000187:drug effects; D018570:Risk Assessment; D012307:Risk Factors; D016540:Smoking Cessation
D000959:Antihypertensive Agents; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors