Cardiovascular complications of chronic kidney disease

Mayne, K. J., Lees, J. S. and Mark, P. B. (2023) Cardiovascular complications of chronic kidney disease. Medicine, 51(3), pp. 190-195. (doi: 10.1016/j.mpmed.2022.12.008)

Abstract

Chronic kidney disease (CKD) is a risk factor for premature cardiovascular disease (CVD). In patients with kidney failure requiring replacement therapy (KFRT) with dialysis or transplantation, CVD risk is greater, approximately 20 times that of the general population. Conventional cardiovascular risk factors such as diabetes, hypertension, smoking and dyslipidaemia worsen both CKD and CVD. Factors specific to CKD, such as proteinuria, impaired calcium–phosphate homeostasis, anaemia and inflammation, also contribute to cardiovascular risk. Atypical relationships exist between blood pressure, cholesterol and mortality in KFRT. Although CKD accelerates atherosclerosis, sudden cardiac death, rather than myocardial infarction, is the predominant mode of cardiac death in KFRT. Left ventricular disorders are common in this population and are associated with mortality as well as cardiac failure. Clinical trials of interventions to improve cardiovascular outcomes have been disappointing in KFRT, although two new treatments have emerged to reduce cardiovascular risk in earlier stages of CKD: sodium-glucose co-transporter 2 (SGLT-2) inhibitors and the non-steroidal mineralocorticoid receptor antagonist (MRA) finerenone. Tight blood pressure control and lipid lowering for primary prevention of CVD are beneficial for patients with CKD not on dialysis. Further evidence is required for interventions targeted at sudden death and other non-conventional risk factors in CKD.

• Item Type: Articles
• Keywords: Cardiovascular disease, cholesterol, chronic kidney disease, diabetes, hypertension, ischaemic heart disease, left ventricular hypertrophy, statins.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Mark, Professor Patrick and Lees, Jennifer and Mayne, Dr Kaitlin
• Authors: Mayne, K. J., Lees, J. S., and Mark, P. B.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Medicine
• Publisher: Elsevier
• ISSN: 1357-3039
• ISSN (Online): 1878-9390
• Published Online: 14 February 2023
• Copyright Holders: Copyright © 2022 Published by Elsevier Ltd.
• First Published: First published in Medicine 51(3): 190-195
• Publisher Policy: Reproduced in accordance with the publisher copyright policy