Epidemiology of cardiovascular risk in patients with chronic kidney disease

Background. Chronic kidney disease (CKD) patients are highly prone to cardiovascular disease for a number of reasons. At the time of starting renal replacement treatment, their cardiovascular condition is already severely compromised, suggesting that cardiovascular risk factors begin to operate very early in the progression of CKD. Moreover, those patients reaching end-stage renal disease without cardiovascular abnormalities have a high probability of developing de novo cardiovascular disease. Methods. In this review, we analyse the prevalence of the major cardiovascular risk factors in CKD patients and their importance as contributors to the excess cardiovascular disease in this population. We also describe and discuss the main results obtained in the management of these risk factors in terms of preventing cardiovascular morbidity and mortality. Results. Hypertension plays a major role in determining cardiac damage at all stages of CKD, including the dialytic phase. Anaemia is a major determinant of the development of left ventricular hypertrophy and therefore its correction can be expected to improve cardiovascular status and long-term survival, but this needs to be done before changes in cardiac structure become well established. Calcium-phosphate disorders are increasingly acknowledged to be cardiovascular risk factors in CKD, yet their medical control is still far from being satisfactory. Dyslipidaemia is particularly frequent in CKD patients, but the benefit of lipid-lowering treatments still has to be proven. Finally, CKD is associated with newly recognized risk factors for atherosclerosis, although their importance as cardiovascular risk factors is still controversial. Conclusions. Nephrologists should attempt to give optimal treatment for well-established cardiovascular risk factors, even if this generally fails to prevent the excess cardiovascular disease of CKD patients. Increasing attention is now being paid to newly recognized CKD-related risk factors for atherosclerosis, although their real importance is still under debate and, before therapeutic prescriptions can be applied to CKD patients, further studies in these new fields are needed.