Cardiovascular Disease in Chronic Kidney Disease

TLDR

Patients with chronic kidney disease have a markedly increased cardiovascular risk, with advanced stages showing higher incidence of coronary artery disease, heart failure, arrhythmias, and sudden cardiac death, driven by a systemic proinflammatory state that accelerates vascular and myocardial remodeling, calcification, and senescence. This overview article aims to summarize the current understanding and clinical consequences of cardiovascular disease in CKD. The authors review and synthesize existing evidence on the pathophysiology and clinical outcomes of cardiovascular disease in CKD.

Abstract

Patients with chronic kidney disease (CKD) exhibit an elevated cardiovascular risk manifesting as coronary artery disease, heart failure, arrhythmias, and sudden cardiac death. Although the incidence and prevalence of cardiovascular events is already significantly higher in patients with early CKD stages (CKD stages 1–3) compared with the general population, patients with advanced CKD stages (CKD stages 4–5) exhibit a markedly elevated risk. Cardiovascular rather than end-stage kidney disease (CKD stage 5) is the leading cause of death in this high-risk population. CKD causes a systemic, chronic proinflammatory state contributing to vascular and myocardial remodeling processes resulting in atherosclerotic lesions, vascular calcification, and vascular senescence as well as myocardial fibrosis and calcification of cardiac valves. In this respect, CKD mimics an accelerated aging of the cardiovascular system. This overview article summarizes the current understanding and clinical consequences of cardiovascular disease in CKD.