Cardiorenal syndrome type 4: From chronic kidney disease to cardiovascular impairment

• Atherosclerosis, arteriosclerosis, and heart impairment are associated with CKD.
• Hyperphosphatemia is tightly related to cardiovascular disease in patients with CKD.
• Post-translational modifications of proteins and peptides play a pivotal role.

Cardiorenal syndrome type 4 (CRS type 4), or chronic renocardiac syndrome, has been defined as “chronic abnormalities in renal function leading to cardiac disease” and recognizes the extreme burden of cardiovascular disease (CVD) risk in patients with chronic kidney disease (CKD). CKD is common and increasingly recognized as a risk factor for CVD. Even though the treatment for CVD has dramatically improved over the past decades, it still takes responsibility for up to 50% of deaths in CKD patients. For this reason, patients with CKD should be thoroughly evaluated for cardiovascular risk factors that require careful management, given the significant burden of CRS type 4 on the healthcare system.This review focuses on the most significant conventional and non-conventional CVD risk factors related to CKD.