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Feature Article

CVD in chronic kidney disease: what do we know?

Muh Geot Wong, Vlado Perkovic

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Abstract

In patients with chronic kidney disease (CKD), cardiovascular disease (CVD) is more frequent and severe, and is often under-recognised and undertreated when compared with the general population. Evidence is now emerging on the efficacy of various management strategies in preventing CVD in people with CKD.

Key Points

  • Chronic kidney disease (CKD) is well recognised as a potent risk factor for cardiovascular disease (CVD), but few trials have specifically addressed the prevention of CVD in the CKD population.
  • Although specific evidence in the CKD population is limited, smoking cessation, exercise, dietary salt reduction and weight loss are generally recommended in patients at all CKD stages.
  • Lipid-lowering therapy with a statin or a statin plus ezetimibe is recommended in patients with CKD (not requiring dialysis); the role of statins in those with end-stage kidney disease (ESKD) is less certain.
  • Evidence supports the lowering of blood pressure (BP) in patients with CKD, aiming for a systolic BP target below 140 mmHg, and below 130 mmHg for those with CKD and proteinuria.
  • Agents acting via the renin-angiotensin system are recommended in patients with CKD primarily for their renal benefit; their efficacy in those with ESKD is less clear.
  • Antiplatelet agents should be used in a similar manner in CKD as they are in the general population, but with even greater caution in patients with CKD at increased risk of bleeding.

    Picture credit: © Bodell Communications Inc

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