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  • Review Article
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Cardiovascular risk factors in patients with chronic kidney disease

Nature Reviews Cardiology volume 6, pages 580–589 (2009)Cite this article

Abstract

Patients with chronic kidney disease have a higher burden of cardiovascular disease, which increases in a dose-dependent fashion with worsening kidney function. Traditional cardiovascular risk factors, including advanced age, diabetes mellitus, hypertension and dyslipidemia, have an important role in the progression of cardiovascular disease in patients who have a reduced glomerular filtration rate, especially in those with mild-to-moderate kidney disease. In patients with severe kidney disease, nontraditional or 'novel' risk factors, including inflammation, oxidative stress, vascular calcification, a prothrombotic milieu, and anemia, seem to confer additional risk. In this Review, we highlight factors that increase cardiovascular risk in patients with a reduced estimated glomerular filtration rate. In addition, we discuss therapeutic strategies for reducing cardiovascular risk in patients with kidney disease, whose unique atherosclerotic phenotype might require an approach that differs from traditional models developed in populations with normal kidney function. Therapeutic paradigms for patients with chronic kidney disease and cardiovascular risk factors must be evaluated in randomized trials, from which such patients have often been excluded.

Key Points

  • With the growing prevalence of shared risk factors, the global burden of cardiovascular disease and chronic kidney disease is increasing rapidly

  • Most studies of patients with cardiovascular disease or high cardiovascular risk demonstrate a graded relationship between degree of kidney disease and adverse cardiovascular outcomes

  • Patients with cardiovascular disease or risk factors such as diabetes mellitus and hypertension should be screened for kidney disease via assessment of estimated glomerular filtration rate and urinary albumin:creatinine ratio

  • Increased cardiovascular risk in patients with kidney disease is probably mediated by both traditional and novel risk factors

  • Evidence-based therapeutic approaches to modification of cardiovascular risk in populations with preserved kidney function seem to be less effective in patients with kidney failure, who exhibit a unique vascular phenotype

  • Treatment paradigms targeted at both traditional and novel atherothrombotic risk factors must be evaluated in randomized trials in patients with kidney disease

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Figure 1: Kaplan-Meier analysis of cardiovascular outcomes according to the presence of chronic kidney disease.
Figure 2: Adjusted estimated probability of kidney function decline as a function of baseline serum creatinine level in patients with and without cardiovascular disease.
Figure 3: Relationship between chronic kidney disease and coronary heart disease.

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  1. The Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Mount Sinai School of Medicine, New York, NY, USA

    Sarina van der Zee, Usman Baber, Sammy Elmariah & Valentin Fuster

  2. Department of Nephrology, Mount Sinai School of Medicine, New York, NY, USA

    Jonathan Winston

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van der Zee, S., Baber, U., Elmariah, S. et al. Cardiovascular risk factors in patients with chronic kidney disease. Nat Rev Cardiol 6, 580–589 (2009). https://doi.org/10.1038/nrcardio.2009.121

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