It is increasingly apparent that individuals with chronic kidney disease (CKD) are more likely to die of cardiovascular (CV) disease (CVD) than to develop kidney failure. However, beyond the effects of lack of appropriate therapy, it is clear that accelerated CVD is prevalent in subjects with CKD. ESRD is associated with several specific complications caused by the uremic state per se, which can contribute to the development and progression of CVD through volume overload with consequent hypertension, anaemia, uremic pericarditis, and cardiomyopathy. However, these issues will not be addressed because the emphasis will be on CKD before ESRD is reached. . In addition, the CV complications associated with dialysis will not be discussed. The different stages of CKD according to the level of glomerular filtration rate (GFR). ESRD corresponds to the stage where patients need renal replacement therapy whereas stage 1 is mostly recognized by either albuminuria or structural renal abnormality. . The increase in risk in comparison to people without CKD depends on the age of the population studied: the younger the person, the higher the relative risk. Micro albuminuria increases the CV risk 2- to 4-fold.

The relationship between renal disease and CV mortality has also been shown to extend to subjects with more moderate degrees of renal functional impairment. In fact, the majority of patients with stage 3 to 4 CKD die of CV causes rather than progress to ESRD. Here too, objective evidence of structural and functional cardiac abnormalities has been demonstrated by echocardiography. A growing number of studies have demonstrated that the relationship between renal dysfunction and increased CV morbidity and mortality extends across the spectrum of renal dysfunction to encompass the mildest degrees of renal impairment. Moreover, this relationship appears to hold across populations with widely varying degrees of baseline CV health.

Regards

Calvin Parker
Editorial Assistant
Journal of Nephrology and Urology