Cardiovascular Disease in Chronic Kidney Disease: Implications of Cardiorespiratory Fitness, Race, and Sex

Cardiovascular disease (CVD) poses a major health burden in adults with chronic kidney disease (CKD). While cardiorespiratory fitness, race, and sex are known to influence the relationship between CVD and mortality in the absence of kidney disease, their roles in patients with CKD remain less clear. Therefore, this narrative review aims to synthesize the existing data on CVD in CKD patients with a specific emphasis on cardiorespiratory fitness, race, and sex. It highlights that both traditional and non-traditional risk factors contribute to CVD development in this population. Additionally, biological, social, and cultural determinants of health contribute to racial disparities and sex differences in CVD outcomes in patients with CKD. Although cardiorespiratory fitness levels also differ by race and sex, their influence on CVD and cardiovascular mortality is consistent across these groups. Furthermore, exercise has been shown to improve cardiorespiratory fitness in CKD patients regardless of race or sex. However, the specific effects of exercise on CVD risk factors in CKD patients, particularly across different races and sexes remains poorly understood and represent a critical area for future research.