Cardiovascular complications of chronic kidney disease

The premature development of cardiovascular diseases is a major factor contributing to the limited lifespan of patients with chronic kidney disease (CKD). Detection and treatment are an important component of patient care and have become a standard part of the workup required before patients can be listed for kidney transplantation. Current guidelines for cardiovascular risk reduction in CKD patients recommend targeting ‘traditional’ risk factors (e.g. hypertension, hypercholesterolaemia), and are based on our knowledge of the benefits of such strategies in the general population. While there are some data to support this approach in patients with stages 1–3 CKD, randomized controlled trials in stage 5 CKD patients receiving dialysis have failed to confirm that well-established cardioprotective therapies (such as statins and angiotensin II converting enzyme inhibitors) are necessarily beneficial. Current opinion is that controlling blood pressure is the most important intervention to reduce cardiovascular disease risk in all CKD patients. In terms of the optimal antihypertensive regimen to reduce the risk of cardiovascular events, there are data to support inclusion of ramipril when treating diabetic patients with microalbuminuria and candesartan or carvedilol when treating haemodialysis patients. The prognosis for CKD patients who suffer a cardiovascular event is poor when compared to individuals with normal kidney function and there is no evidence to suggest that secondary prevention strategies are any more or less effective than in other populations.