Cardiovascular morbidity and mortality in patients with kidney disease

Patients with kidney disease have a significantly increased cardiovascular morbidity and mortality. Especially diabetics have an increased risk to develop renal insufficiency and cardiovascular events. Two recent studies show that the SGLT2 inhibitor Empagliflozin and the GLP1 agonist Liraglutid are able to lower the cardiovascular risk of type2 diabetics with renal insufficiency. Recent observations suggest that bradycardia and asystole are main triggers for sudden cardiac death in patients with chronic kidney disease. In line with these results registry data failed to confirm benefits of cardioverters/defibrillators in hemodialysis patients. Whether cardiac resynchronization therapy may slower pathomechanisms of cardiomyopathy in patients with chronic kidney disease still needs to be confirmed in prospective trials. Taken together implementation of device therapy in hemodialysis patients should integrate indications of current guidelines with individual patient risks and life expectancy. Everolimus-eluting stents have shown superior results compared to bare metal stents in terms of ischemia-driven target-lesion-revascularization in patients with chronic kidney disease in a prospective trial. These results were corroborated by registry data reporting survival benefit associated with the use of drug-eluting stents in patients with chronic renal disease.