title: Management of cardiovascular disease in patients with kidney disease.
abstract: The burden of cardiovascular disease is high in patients with chronic kidney disease or end-stage renal disease. The presence of kidney dysfunction affects the cardiovascular system in multiple ways, including accelerated progression of atherosclerosis and valvular disease, the exacerbation of congestive heart failure, and the development of pericardial disease. This comorbidity results not only from the concordance of shared risk factors, but also from other issues specific to this population, such as systemic inflammation and vascular calcification. Furthermore, both the sensitivity and specificity of noninvasive testing modalities, and the efficacy of several pharmacotherapeutic strategies, are diminished in this population. The exclusion of patients with severe kidney disease from many clinical trials of cardiac interventions raises various therapeutic uncertainties, and kidney disease itself is likely to alter the underlying cardiovascular physiology. In this Review, we discuss aspects of the epidemiology, pathophysiology, and diagnosis of cardiovascular disease in patients with kidney disease, and propose specific, evidence-based recommendations for pharmacological and surgical treatment.
authors: Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, One Gustave L. Levy Place, PO Box 1030, New York, NY 10029-6574, USA. mark.kahn@ mountsinai.org
authors: Mark R
authors: MR
authors: Kahn
authors: Michael J
authors: MJ
authors: Robbins
authors: Michael C
authors: MC
authors: Kim
authors: Valentin
authors: V
authors: Fuster
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D016030:Kidney Transplantation; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D006435:Renal Dialysis / Q000009:adverse effects; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents