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  • Review Article
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Management of cardiovascular disease in patients with kidney disease

Nature Reviews Cardiology volume 10, pages 261–273 (2013)Cite this article

Subjects

Abstract

The burden of cardiovascular disease is high in patients with chronic kidney disease or end-stage renal disease. The presence of kidney dysfunction affects the cardiovascular system in multiple ways, including accelerated progression of atherosclerosis and valvular disease, the exacerbation of congestive heart failure, and the development of pericardial disease. This comorbidity results not only from the concordance of shared risk factors, but also from other issues specific to this population, such as systemic inflammation and vascular calcification. Furthermore, both the sensitivity and specificity of noninvasive testing modalities, and the efficacy of several pharmacotherapeutic strategies, are diminished in this population. The exclusion of patients with severe kidney disease from many clinical trials of cardiac interventions raises various therapeutic uncertainties, and kidney disease itself is likely to alter the underlying cardiovascular physiology. In this Review, we discuss aspects of the epidemiology, pathophysiology, and diagnosis of cardiovascular disease in patients with kidney disease, and propose specific, evidence-based recommendations for pharmacological and surgical treatment.

Key Points

  • The substantial morbidity and mortality from coronary artery disease (CAD) in patients with chronic kidney disease or end-stage renal disease (ESRD) make the effective management of these conditions critical

  • The high burden of CAD in patients with kidney disease is related to both shared traditional risk factors and issues specific to this population, including systemic inflammation and vascular calcification

  • Some medications, such as statins, have been found to be beneficial in the early stages of kidney disease, but have not proved to be effective in patients with ESRD

  • Pressure and volume overload in patients with kidney disease lead to left ventricular changes and congestive heart failure, which necessitate medical therapy and, potentially, ultrafiltration for fluid removal

  • No robust data exist regarding prophylactic coronary revascularization in asymptomatic patients with kidney disease; adherence to the current guidelines for revascularization in the general population seems reasonable

  • Randomized controlled trials in patients with moderate-to-severe kidney disease—individuals who are often excluded from clinical trials—are sparse, which makes therapeutic decisions in this population challenging

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Figure 1: Relationship between chronic kidney disease and coronary artery disease.
Figure 2: Pathophysiology of the cardiorenal syndrome.
Figure 3: Treatment of cardiovascular diseases in patients with kidney disease.

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  1. Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, One Gustave L. Levy Place, P.O. Box 1030, New York, 10029-6574, NY, USA

    Mark R. Kahn, Michael J. Robbins, Michael C. Kim & Valentin Fuster

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Kahn, M., Robbins, M., Kim, M. et al. Management of cardiovascular disease in patients with kidney disease. Nat Rev Cardiol 10, 261–273 (2013). https://doi.org/10.1038/nrcardio.2013.15

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