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  • Review Article
  • Published:

Global cardiovascular protection in chronic kidney disease

Nature Reviews Cardiology volume 13, pages 603–608 (2016)Cite this article

Subjects

Key Points

  • Chronic kidney disease (CKD) is accompanied by a very substantial increase in cardiovascular risk

  • Inhibitors of the renin–angiotensin–aldosterone system (RAAS) are frequently underprescribed because of the risk of hyperkalaemia

  • Use of statins at high doses might reduce cardiovascular risk in patients with CKD

  • New potassium binders can enhance RAAS blockade without increasing the risk of hyperkalaemia

  • New nonsteroidal mineralocorticoid-receptor antagonists that reduce the risk of hyperkalaemia are being tested in trials

  • Patients with heart failure treated with LCZ696 show a clear improvement in cardiovascular outcomes accompanied by improved renal function and reduced hyperkalaemia

Abstract

The development and progression of cardiovascular disease (CVD) and renal disorders are very closely related. In patients with chronic kidney disease (CKD), therapies proven to protect the cardiovascular and renal systems simultaneously are generally used only at low doses or not at all. In particular, patients with CKD who receive angiotensin-converting-enzyme inhibitors, angiotensin-receptor blockers, or mineralocorticoid-receptor antagonists (MRAs) often do not experience complete blockade of the renin–angiotensin–aldosterone system, primarily owing to the risk of hyperkalaemia. In this Review, we provide an overview of the available treatments required for adequate cardiorenal protection in patients with CKD. Drugs such as β-blockers that interfere with renin secretion will be discussed, in addition to agents that can prevent hyperkalaemia, such as potassium binders and nonsteroidal MRAs. Furthermore, the current literature on the role of statins, in addition to new compounds and dosing recommendations for the treatment of patients with CKD will also be reviewed. Further studies with these new compounds and doses are needed to ascertain whether these approaches can improve the long-term cardiovascular and renal prognosis in patients with CKD.

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Figure 1: Risk categories for kidney and mortality outcomes by glomerular filtration rate (GFR) and albuminuria stage.
Figure 2: Potential strategies to overcome the development of hyperkalaemia.
Figure 3: Therapies effective for treating both cardiovascular disease (CVD) and chronic kidney disease (CKD).

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Acknowledgements

We thank the Spanish Ministry of Health, Instituto de Salud Carlos III (PI11/02432, PIE13/00045, PI14/01841, CP15/00129), Spanish Ministry of Science and Innovation (SAF2011-25303), Fundación SENEFRO, and Fondos FEDER.

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Authors and Affiliations

  1. Unidad de Hipertensión and Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, Madrid, 28041, Spain

    Gema Ruiz-Hurtado, María S. Fernández-Alfonso & Luis M. Ruilope

  2. Instituto Pluridisciplinar and Facultad de Farmacia, Universidad Complutense de Madrid, Paseo Juan XXIII 1, Madrid, 28040, Spain

    Gema Ruiz-Hurtado & María S. Fernández-Alfonso

  3. Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, 541 24, Greece

    Pantelis Sarafidis

  4. Division of Clinical Pathophysiology, Centre Hospitalier Universitaire Vaudois, Chemin des Boveresses 155, Epalinges, 1066, Switzerland

    Bernard Waeber

  5. Departamento de Salud Pública y Medicina Preventiva, Universidad Autónoma de Madrid, Arzobispo Morcillo 4, Madrid, 28049, Spain

    Luis M. Ruilope

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P.S., M.S.F.-A., and B.W. discussed the content of the article, and reviewed and edited the manuscript before submission. G.R.-H. and L.M.R. researched data, discussed the content, wrote the article, and reviewed and edited the manuscript before submission.

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Ruiz-Hurtado, G., Sarafidis, P., Fernández-Alfonso, M. et al. Global cardiovascular protection in chronic kidney disease. Nat Rev Cardiol 13, 603–608 (2016). https://doi.org/10.1038/nrcardio.2016.48

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