Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO)

Abstract

Cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD) is high, and the presence of CKD worsens outcomes of cardiovascular disease (CVD). CKD is associated with specific risk factors. Emerging evidence indicates that the pathology and manifestation of CVD differ in the presence of CKD. During a clinical update conference convened by the Kidney Disease: Improving Global Outcomes (KDIGO), an international group of experts defined the current state of knowledge and the implications for patient care in important topic areas, including coronary artery disease and myocardial infarction, congestive heart failure, cerebrovascular disease, atrial fibrillation, peripheral arterial disease, and sudden cardiac death. Although optimal strategies for prevention, diagnosis, and management of these complications likely should be modified in the presence of CKD, the evidence base for decision making is limited. Trials targeting CVD in patients with CKD have a large potential to improve outcomes.

Prognostic study of cardiac events in Japanese patients with chronic kidney disease using ECG-gated myocardial Perfusion imaging: Final 3-year report of the J-ACCESS 3 study

“…4,12,21 Indeed, a diagnosis of CAD might be problematic in the setting of CKD, since such patients frequently do not experience ischemic symptoms, elevated cardiac biomarkers, and ECG changes. 3,4,22 Although coronary angiography has been considered the gold standard for detecting CAD, contrast media-induced nephropathy or cholesterol microembolization has emerged as serious problems. 9 Figure 2.…”

“…[1][2][3][4] Several studies have shown that the adjusted hazard ratio for death and cardiovascular events increases inversely with estimated glomerular filtration rates (eGFR). 1,2 An estimated 13% of the Japanese adult population has CKD.…”

Non–ST‐Segment–Elevation Myocardial Infarction Among Patients With Chronic Kidney Disease: A Propensity Score–Matched Comparison of Percutaneous Coronary Intervention Versus Conservative Management

“…Patients with CKD have accelerated atherosclerosis and an increased risk of myocardial infarction, with cardiovascular disease remaining the most common cause of death 3. Based on previous seminal studies,4, 5, 6 the 2014 American College of Cardiology/American Heart Association (ACC/AHA) and the 2015 European Society of Cardiology guidelines recommend an urgent invasive strategy in high‐risk patients presenting with non–ST‐segment–elevation myocardial infarction (NSTEMI) 7, 8.…”

Community Noise Exposure and its Effect on Blood Pressure and Renal Function in Patients with Hypertension and Cardiovascular Disease

“…In fact, subgroup analyses have revealed that the noise-attributed increase in BP was somewhat higher in CVD and diabetic patients in comparison to the rest. 13,19 Although the decline in renal function increases the risk of CVD morbidity and mortality 20 , there are no data on its relationship with RTN. One previous study, however, reported signifi cantly lower glomerular fi ltration rate in stroke survivors who lived within 50 m of a major road.…”