Strategies to manage cardiovascular risk in chronic kidney disease

Cardiovascular disease (CVD) remains the leading cause of death across the spectrum of chronic kidney disease (CKD), including CKD not requiring dialysis and for patients requiring dialysis or kidney transplantation. There is a high prevalence of ‘conventional’ cardiovascular risk factors in patients with CKD such as hypertension, dyslipidaemia, diabetes mellitus, smoking, low physical activity/obesity and prior cardiovascular events. Many risk factors contribute to the aetiology and pathogenesis of CKD or are shared risk factors for CKD progression [1]. Furthermore, there are contributors to accelerated CVD specific to, or exaggerated in CKD. Examples include left ventricular hypertrophy (LVH), fluid and electrolyte shifts, proteinuria, functional vitamin D deficiency, hyperphosphataemia, chronic inflammation, vascular stiffness and/or vascular calcification. There are multiple other putative mechanisms for accelerated CVD in CKD patients, identified by phenotyping using state of the art imaging, physiological studies and molecular biology, although these are yet to translate to clinical practice. This NDT Digest will discuss the current clinical evidence for addressing CVD risk in CKD