How Does Minor Renal Dysfunction Influence Cardiovascular Risk and the Management of Cardiovascular Disease?

Pinkau, Tobias; Hilgers, Karl F.; Veelken, Roland; Mann, Johannes F.E.

doi:10.1097/01.asn.0000107565.17553.71

Cited by 58 publications

(45 citation statements)

References 49 publications

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“…The group with mild renal impairment had small, borderline significant increases in CAD and CVD compared to those with normal renal function. The findings confirmed prior observations that impaired renal function is an independent risk factor for CAD/ CVD [34,35].…”

Section: Choice Of Antihypertensive Agentssupporting

confidence: 92%

Hypertension and kidney protection in the elderly: what is the evidence in 2007?

Lindeman

2007

Int Urol Nephrol

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Hypertension and diabetes mellitus are the two most widely recognized risk factors for cardiovascular disease (CVD), chronic kidney disease (CKD), and end-stage renal disease (ESRD) requiring dialysis/transplantation; both become increasingly important as one ages. Common pathways and mechanisms are involved in the development of renal vascular lesions in both conditions, and effective treatments for each are now available to reduce morbidity, mortality and progression of organ damage. Although this review will focus primarily on the ability to protect the kidney and vasculature elsewhere by lowering blood pressure in the elderly, other approaches, specifically dietary restriction of protein, strict control of diabetes mellitus, and the management of the different dyslipidemias, must be used in conjunction with the antihypertensive agents to obtain optimum protection.

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Section: Choice Of Antihypertensive Agentssupporting

confidence: 92%

Hypertension and kidney protection in the elderly: what is the evidence in 2007?

Lindeman

2007

Int Urol Nephrol

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“…The strong association of proteinuria with poor BP control may be attributable to the tight relationship of proteinuria with vascular disease. 17 Although low GFR is recognized as a cardiovascular risk factor, 15,18 proteinuria in patients with CKD may be a better marker of the presence of vascular disease. 19 The shared mechanisms that underlie poor vascular compliance, proteinuria, and systolic hypertension may account for the strong association between proteinuria and systolic hypertension in CKD.…”

Section: Discussionmentioning

confidence: 99%

Correlates of Systolic Hypertension in Patients With Chronic Kidney Disease

2005

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Abstract-Hypertension in patients with chronic kidney disease (CKD) is predominantly systolic. The contribution of risk factors for hypertension to the overall systolic blood pressure (BP) is unknown. To study the relationship between risk factors for hypertension and systolic BP in patients with CKD, 232 veterans (mean age 67 years; 96% men; 20% black; 39% with diabetes mellitus; estimated glomerular filtration rate [GFR] 48 mL/min per 1.73 m 2 ) had clinic (routine and standardized measurements) and out-of-clinic (home and 24-hour ambulatory) BPs recorded. In multivariate analysis, using 17 risk factors, the log of the urine protein/creatinine ratio was the strongest predictor of systolic BP regardless of the BP measurement technique. The strength of the relationship between proteinuria and systolic BP was in the order ambulatory Ͼ home Ͼ standardized clinic Ͼ routine clinic BP measurement. Other independent predictors were age, race, and number of antihypertensive drugs used, and the model fit was better for out-of-clinic than clinic BP recordings. Estimated GFR was not an independent predictor of systolic BP by any technique. Nocturnal dipping was associated with higher estimated GFR, higher serum albumin, younger age, and less proteinuria. Proteinuria is the most important correlate of systolic BP in older men, the strongest relationship of which was with ambulatory and home systolic BP. Out-of-clinic BP recordings correlate better with target organ damage, as measured by proteinuria, and may be of greater clinical value than clinic BP recordings in predicting hypertension-related outcomes such as end-stage renal disease and death. (Hypertension. 2005;46:514-520.) Key Words: proteinuria Ⅲ kidney H ypertension is very common in patients with chronic kidney disease (CKD); its prevalence increases with falling glomerular filtration rate (GFR) and reaches an estimated 86% in patients with end-stage renal disease (ESRD). 1 In the third National Health and Nutrition Examination Survey, 70% of those with an elevated serum creatinine had hypertension. 2 Sodium and water retention with progressive decrease in GFR is thought to be etiologically related to the high prevalence of hypertension. However, many other factors such as activation of sympathoadrenal system, renin-angiotensin system, and circulating inhibitors of NO are also responsible for the high prevalence of hypertension. 3 Although blood pressure (BP) control is paramount in preventing the progression of renal disease, factors related to BP control in the CKD population have scarcely been examined. In the Modification of Diet in Renal Disease (MDRD) study, 5 risk factors were found to be independent predictors of the presence of hypertension. 4 In decreasing order of significance, these factors were GFR, body mass index (BMI), black race, increasing age, and male gender. In a survey of 1921 patients with CKD in Europe, the odds of presence of hypertension were increased independently by the following risk factors listed in the order of significance: creat...

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“…Accelerated atherosclerosis and its consequences have been documented in very early stages of renal disease. This was true even when classic risk factors were absent [69,70]. The adverse consequences of minor renal dysfunction have been well documented by studies in the general population [71,72], in patients with hypertension [73] or in patients at high cardiovascular risk [74].…”

Section: Increased Coronary Risk In Very Early Renal Failurementioning

confidence: 80%

Atherosclerosis in Dialyzed Patients

Ritz¹

2004

Blood Purif

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In the recent HEMO study, the most common cause of death in dialyzed patients was ischemic heart disease. In Europe there are regional differences, but the mortality due to cardiovascular disease is also very high. The long-lasting controversy whether the high incidence and prevalence of atherosclerotic manifestations (particularly ischemic heart disease) may be explained by known risk factors, or non-traditional risk factors are also involved seems to be partially solved with the increasing evidence that the latter hypothesis is true. Thus, together with classic risk factors such as hypertension, dyslipidemia and diabetes, other situations such as microinflammation, increased concentration of asymmetrical dimethyl-L-arginine, disturbed phosphate metabolism and anemia may represent important risk factors for accelerated atherosclerosis in dialyzed patients.

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How Does Minor Renal Dysfunction Influence Cardiovascular Risk and the Management of Cardiovascular Disease?

Cited by 58 publications

References 49 publications

Hypertension and kidney protection in the elderly: what is the evidence in 2007?

Hypertension and kidney protection in the elderly: what is the evidence in 2007?

Correlates of Systolic Hypertension in Patients With Chronic Kidney Disease

Atherosclerosis in Dialyzed Patients

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