Cardiovascular disease (CVD) is the most common cause of death in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). The clinical epidemiology of CVD in CKD is challenging due to a prior lack of standardized definitions of CKD, inconsistent measures of renal function, and possible alternative effects of ‘traditional’ CVD risk factors in patients with CKD. These challenges add to the complexity of the role of renal impairment as the cause or the consequence of cardiovascular disease. The goal of this review is to summarize the current evidence on: (1) the incidence and prevalence of CVD in chronic renal insufficiency and in ESRD, (2) risk factors for CVD in CKD, (3) the outcomes of patients with renal failure with CVD, and (4) CKD as a risk factor for CVD. The epidemiological associations implicating the huge burden of CVD throughout all stages of CKD highlight the need to better understand and implement adequate screening, and diagnostic and treatment strategies.

Keywords:
Cardiovascular disease, Chronic kidney disease
1.
Clase CM GA, Kiberd BA: Estimating the prevalence of low glomerular filtration rate requires attention to the creatinine assay calibration. J Am Soc Nephrol 2002;13:2811–2816.
2.
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY: Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization (see comment). N Engl J Med 2004;351:1296–1305.
3.
Jungers P, Massy ZA, Khoa TN, Fumeron C, Labrunie M, Lacour B, Descamps-Latscha B, Man NK: Incidence and risk factors of atherosclerotic cardiovascular accidents in predialysis chronic renal failure patients: a prospective study. Nephrol Dial Transplant 1997;12:2597–2602.
4.
Levin A, Djurdjev O, Barrett B, Burgess E, Carlisle E, Ethier J, Jindal K, Mendelssohn D, Tobe S, Singer J, Thompson C: Cardiovascular disease in patients with chronic kidney disease: Getting to the heart of the matter. Am J Kidney Dis 2001;38:1398–1407.
5.
Manjunath G, Tighiouart H, Ibrahim H, MacLeod B, Salem DN, Griffith JL, Coresh J, Levey AS, Sarnak MJ: Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community. J Am Coll Cardiol 2003;41:47–55.
6.
Culleton BF, Larson MG, Wilson PW, Evans JC, Parfrey PS, Levy D: Cardiovascular disease and mortality in a community-based cohort with mild renal insufficiency. Kidney Int 1999;56:2214–2219.
7.
Levin A, Singer J, Thompson CR, Ross H, Lewis M: Prevalent left ventricular hypertrophy in the predialysis population: Identifying opportunities for intervention. Am J Kidney Dis 1996;27:347–354.
8.
Anavekar NS, McMurray JJ, Velazquez EJ, Solomon SD, Kober L, Rouleau JL, White HD, Nordlander R, Maggioni A, Dickstein K, Zelenkofske S, Leimberger JD, Califf RM, Pfeffer MA: Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction [see comment]. N Engl J Med 2004;351:1285–1295.
9.
Foley RN, Herzog CA, Collins AJ: Smoking and cardiovascular outcomes in dialysis patients: The United States Renal Data System Wave 2 Study. Kidney Int 2003;63:1462–1467.
10.
Kasiske BL: Risk factors for accelerated atherosclerosis in renal transplant recipients. Am J Med 1988;84:985–992.
11.
Foley RN, Parfrey PS, Harnett JD, Kent GM, Martin CJ, Murray DC, Barre PE: Clinical and echocardiographic disease in patients starting end-stage renal disease therapy. Kidney Int 1995;47:186–192.
12.
Foley RN, Herzog CA, Collins AJ: Blood pressure and long-term mortality in United States hemodialysis patients: USRDS Waves 3 and 4 Study. Kidney Int 2002;62:1784–1790.
13.
Kopple JD, Zhu X, Lew NL, Lowrie EG: Body weight-for-height relationships predict mortality in maintenance hemodialysis patients. Kidney Int 1999;56:1136–1148.
14.
Zager PG, Nikolic J, Brown RH, Campbell MA, Hunt WC, Peterson D, Van Stone J, Levey A, Meyer KB, Klag MJ, Johnson HK, Clark E, Sadler JH, Teredesai P: ‘U’ curve association of blood pressure and mortality in hemodialysis patients. Medical Directors of Dialysis Clinic, Inc. Kidney Int 1998;54:561–569.
15.
Foley RN, Parfrey PS, Harnett JD, Kent GM, Murray DC, Barre PE: Impact of hypertension on cardiomyopathy, morbidity and mortality in end-stage renal disease. Kidney Int 1996;49:1379–1385.
17.
Flack JM, Neaton JD, Daniels B, Esunge P: Ethnicity and renal disease: Lessons from the Multiple Risk Factor Intervention Trial and the Treatment of Mild Hypertension Study. Am J Kidney Dis 1993;21:31–40.
18.
Manjunath G, Tighiouart H, Coresh J, Macleod B, Salem DN, Griffith JL, Levey AS, Sarnak MJ: Level of kidney function as a risk factor for cardiovascular outcomes in the elderly. Kidney Int 2003;63:1121–1129.
19.
Herzog CA, Ma JZ, Collins AJ: Poor long-term survival after acute myocardial infarction among patients on long-term dialysis. N Engl J Med 1998;339:799–805.
20.
Rigatto C: Clinical epidemiology of cardiac disease in renal transplant recipients. Semin Dial 2003;16:106–110.
21.
Ruilope LM, Salvetti A, Jamerson K, Hansson L, Warnold I, Wedel H, Zanchetti A: Renal function and intensive lowering of blood pressure in hypertensive participants of the hypertension optimal treatment (HOT) study. J Am Soc Nephrol 2001;12:218–225.
22.
Lok CE, Austin PC, Wang H, Tu JV: Impact of renal insufficiency on short- and long-term outcomes after cardiac surgery. Am Heart J 2004;148:430–438.
23.
Schillaci G, Reboldi G, Verdecchia P: High-normal serum creatinine concentration is a predictor of cardiovascular risk in essential hypertension. Arch Intern Med 2001;161:886–891.
24.
Hemmelgarn BR, Ghali WA, Quan H, Brant R, Norris CM, Taub KJ, Knudtson ML: Poor long-term survival after coronary angiography in patients with renal insufficiency (see comment). Am J Kidney Dis 2001;37:64–72.
25.
Shulman NB, Ford CE, Hall WD, Blaufox MD, Simon D, Langford HG, Schneider KA: Prognostic value of serum creatinine and effect of treatment of hypertension on renal function. Results from the hypertension detection and follow-up program. The Hypertension Detection and Follow-up Program Cooperative Group. Hypertension 1989;13:I80–I93.
26.
Dries DL, Exner DV, Domanski MJ, Greenberg B, Stevenson LW: The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction. J Am Coll Cardiol 2000;35:681–689.
27.
Mann JF, Gerstein HC, Pogue J, Bosch J, Yusuf S: Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial. Ann Intern Med 2001;134:629–636.
28.
Fried LP, Kronmal RA, Newman AB, Bild DE, Mittelmark MB, Polak JF, Robbins JA, Gardin JM: Risk factors for 5-year mortality in older adults: The Cardiovascular Health Study. JAMA 1998;279:585–592.
29.
Manolio TA, Kronmal RA, Burke GL, O’Leary DH, Price TR: Short-term predictors of incident stroke in older adults. The Cardiovascular Health Study. Stroke 1996;27:1479–1486.
30.
Wannamethee SG, Shaper AG, Perry IJ: Serum creatinine concentration and risk of cardiovascular disease: A possible marker for increased risk of stroke. Stroke 1997;28:557–563.
31.
Henry RM, Kostense PJ, Bos G, Dekker JM, Nijpels G, Heine RJ, Bouter LM, Stehouwer CD: Mild renal insufficiency is associated with increased cardiovascular mortality: The Hoorn Study. Kidney Int 2002;62:1402–1407.
32.
Garg AX, Clark WF, Haynes RB, House AA: Moderate renal insufficiency and the risk of cardiovascular mortality: Results from the NHANES I. Kidney Int 2002;61:1486–1494.
33.
Beddhu S, Allen-Brady K, Cheung AK, Horne BD, Bair T, Muhlestein JB, Anderson JL: Impact of renal failure on the risk of myocardial infarction and death. Kidney Int 2002;62:1776–1783.
34.
Muntner P, He J, Hamm L, Loria C, Whelton PK: Renal insufficiency and subsequent death resulting from cardiovascular disease in the United States. J Am Soc Nephrol 2002;13:745–753.
35.
Hsu CY, Chertow GM: Chronic renal confusion: insufficiency, failure, dysfunction, or disease. Am J Kidney Dis 2000;36:415–418.
36.
Weiner DE, Tighiouart H, Amin MG, Stark PC, MacLeod B, Griffith JL, Salem DN, Levey AS, Sarnak MJ: Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: A pooled analysis of community-based studies. J Am Soc Nephrol 2004;15:1307–1315.
© 2005 S. Karger AG, Basel
2005
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.