Cardiovascular disease in chronic kidney disease: untying the Gordian knot.
Chronic kidney disease (CKD) affects around 10-13% of the general population, with only a small proportion in end stage renal disease (ESRD), either on dialysis or awaiting renal transplantation. It is well documented that CKD patients have an extremely high risk of developing cardiovascular disease (CVD) compared with the general population, so much so that in the early stages of CKD patients are more likely to develop CVD than they are to progress to ESRD. Various pathophysiological pathways and explanations have been advanced and suggested to account for this, including endothelial dysfunction, dyslipidaemia, inflammation, left ventricular hypertrophy and cardiac autonomic dysfunction. In this review, we try to understand and further explore the link between CKD and CVD, as well as offering interventional advice where available, while exposing the current lack of RCT-based research and trial evidence in this area. We also suggest pragmatic Interim measures we could take while we wait for definitive RCTs.
MRC Centre for Transplantation and Renal Unit, Guy's & St. Thomas' NHS Foundation Trust, King's College Academic Health Partners, London, UK.
R
R
Hajhosseiny
K
K
Khavandi
D J
DJ
Goldsmith
D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D001342:Autonomic Nervous System Diseases / Q000209:etiology; D015415:Biomarkers / Q000378:metabolism; D001786:Blood Glucose / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000150:complications* / Q000503:physiopathology / Q000517:prevention & control; D003324:Coronary Artery Disease / Q000209:etiology; D050171:Dyslipidemias / Q000209:etiology; D004730:Endothelium, Vascular / Q000503:physiopathology; D006801:Humans; D020138:Hyperhomocysteinemia / Q000209:etiology / Q000517:prevention & control; D006949:Hyperlipidemias / Q000209:etiology / Q000517:prevention & control; D006973:Hypertension / Q000209:etiology / Q000517:prevention & control; D017379:Hypertrophy, Left Ventricular / Q000209:etiology; D008019:Life Style; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology
D000318:Adrenergic beta-Agonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000975:Antioxidants; D015415:Biomarkers; D001786:Blood Glucose