Cardiovascular complications of chronic renal disease

Chronic kidney disease (CKD) is common and increasingly recognized as a risk factor for premature cardiovascular disease (CVD). In patients with end stage renal disease (ESRD) requiring dialysis the risk of CVD is even greater, approximately 20 times that of the general population. Conventional cardiovascular risk factors such as diabetes, hypertension, smoking and hyperlipidaemia exacerbate both CKD and CVD. Other factors, more specific to CKD, such as proteinuria, left ventricular hypertrophy, impaired calcium–phosphate homeostasis, anaemia and inflammation contribute to cardiovascular risk in this population. Atypical relationships exist between blood pressure, cholesterol and mortality in ESRD. Although CKD is a state of accelerated atherosclerosis, the commonest mode of cardiovascular death in ESRD is sudden cardiac death rather than myocardial infarction. Left ventricular disorders are common in this population and are associated with mortality as well as cardiac failure. Clinical trials of interventions to improve cardiovascular outcomes have been somewhat disappointing in ESRD. Tight blood pressure control and lipid lowering for primary prevention of CVD are beneficial for patients with CKD not on dialysis and transplant recipients at otherwise increased cardiovascular risk. Further evidence is required for interventions targeted at sudden death and other non-conventional risk factors in CKD and ESRD patients.