Cardiovascular disease in the chronic kidney disease population - burden, pathophysiology and end-organ manifestations

Individuals with chronic kidney disease have a disproportionate risk of cardiovascular disease which accounts for the majority of the morbidity and mortality in this population. While traditional cardiovascular risk factors are overrepresented in the chronic kidney disease population, this alone is not sufficient to explain the excess risk observed. Chronic kidney disease is also associated with a number of novel pathophysiological mechanisms including salt and water retention, bone and mineral disorders, sympathetic overactivity and oxidative stress which combine to cause a number of pathological cardiovascular changes unique to chronic kidney disease. A greater understanding of these mechanisms is the first step to developing effective cardiac risk monitoring strategies and therapies. This chapter reviews the pathophysiology of cardiovascular disease in the chronic kidney disease population with a particular focus on those mechanisms unique to chronic kidney disease, their physiological consequences and end-organ effects