Cardiovascular disease in patients with chronic kidney disease

Excerpt

Patients with chronic kidney disease (CKD) have an increased risk of developing cardiovascular disease with its sequelae of coronary artery disease, heart failure, and sudden cardiac death. Overall, cardiovascular risk in CKD patients is extremely elevated compared with patients who do not have CKD, leading to a significantly enhanced morbidity and mortality once kidney function declines. In fact, the chances of patients with advanced CKD ever reaching the dialysis stage are lower than dying from cardiovascular disease. Ironically, these cardiovascular high-risk patients are often undertreated because of possibly atypical symptoms, concerns about diagnostic work-up involving radiocontrast agents, uncertainty about drugs allowed in advanced CKD, and others. In addition, CKD not only influences the clinical course of cardiovascular disease but also limits the benefit of classic cardiovascular risk-reducing treatments such as lipid-lowering therapy, and, furthermore, the presence of CKD impairs the prognosis of patients after cardiac interventions such as transcatheter aortic valve implantation. Moreover, given the exclusion of patients with advanced CKD from most cardiovascular outcome trials, the database for evidence-based recommendations to treat these patients is limited. …