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  • Review Article
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Cardiovascular risk and management in chronic kidney disease

Nature Reviews Nephrology volume 5, pages 287–296 (2009)Cite this article

Abstract

Chronic kidney disease (CKD) is associated with accelerated progression of cardiovascular disease, perhaps because patients with CKD have a high burden of traditional cardiovascular risk factors in addition to a range of nontraditional risk factors such as inflammation and abnormal metabolism of calcium and phosphate. Although the cardiovascular burden of CKD is well documented, potentially beneficial therapies are sometimes underused in patients with stage 3–4 CKD and are rarely studied in patients on dialysis. In this Review, we describe the epidemiology of cardiovascular disease in patients with stage 3–5 CKD (excluding kidney transplant recipients) and outline cardiovascular risk factors that are relevant in this population; we then discuss the implications of this knowledge for the optimal management of cardiovascular risk in this setting. Finally, we highlight opportunities for further research.

Key Points

  • Chronic kidney disease (CKD) is considered an independent cardiovascular risk factor

  • Although people with CKD carry a high burden of traditional cardiovascular risk factors, a host of other nontraditional risk factors might also contribute to their excess cardiovascular risk

  • Available data suggest that there is little reason to manage cardiovascular risk in patients with stage 3–4 CKD differently than in the general population

  • Strong recommendations about cardioprotective treatment are difficult to make in patients on dialysis; guidelines for the general population should be cautiously followed, with careful attention to adverse events

  • Clinicians should consider enrolling patients on dialysis in randomized trials of cardioprotective therapies

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Figure 1: Contribution of traditional, nontraditional and dialysis-related risk factors to the cardiovascular burden of patients with chronic kidney disease.

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Acknowledgements

Dr Tonelli was supported by salary awards from the Canadian Institutes of Health Research and the Alberta Heritage Foundation for Medical Research.

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  1. Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada

    Diana Rucker

  2. Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, AB, Canada

    Marcello Tonelli

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M. Tonelli has received grant/research support from Pfizer. D. Rucker declared no competing interests.

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Rucker, D., Tonelli, M. Cardiovascular risk and management in chronic kidney disease. Nat Rev Nephrol 5, 287–296 (2009). https://doi.org/10.1038/nrneph.2009.42

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