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Nontraditional risk factors for cardiovascular disease in patients with chronic kidney disease

Nature Clinical Practice Nephrology volume 4, pages 672–681 (2008)Cite this article

Abstract

Patients with chronic kidney disease (CKD) have a reduced lifespan, and a substantial proportion of these individuals die from cardiovascular disease. Although a large percentage of patients with CKD have traditional cardiac risk factors such as diabetes, hypertension and abnormalities in cholesterol, interventions to address these factors—which have significantly decreased cardiovascular mortality in the general population—have not shown such benefit in the CKD population. In addition, the severity and extent of cardiovascular complications in patients with CKD is disproportionate to the number and severity of traditional risk factors. This realization has focused attention on nontraditional cardiac risk factors that are particularly relevant to patients with CKD, including decreased hemoglobin levels, microalbuminuria, increased inflammation and oxidative stress, and abnormalities in bone and mineral metabolism. However, large prospective trials in patients with advanced CKD or in those requiring chronic dialysis have not shown that normalization of these nontraditional risk factors improves survival. Moreover, the mechanisms by which these nontraditional risk factors contribute to cardiovascular disease are unknown. Therefore, although current treatment of patients with CKD includes management of traditional and nontraditional risk factors, the value of modifying some nontraditional risk factors remains unclear.

Key Points

  • Patients with chronic kidney disease (CKD) have a very high risk of cardiovascular events and death

  • Patients with CKD have a high prevalence of traditional and nontraditional cardiac risk factors

  • Nontraditional cardiac risk factors, including anemia, inflammation, oxidative stress and hyperphosphatemia, are associated with cardiovascular disease in patients with CKD

  • The mechanisms by which these nontraditional risk factors contribute to cardiovascular disease in CKD are not well understood

  • Treatment of CKD includes management of traditional and nontraditional cardiovascular risk factors, but the value of modifying some nontraditional risk factors remains unclear

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  1. J Kendrick is a first-year Nephrology Fellow and MB Chonchol is an Associate Professor of Medicine at the University of Colorado Health Sciences Center in Denver, CO, USA.,

    Jessica Kendrick & Michel B Chonchol

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Correspondence to Michel B Chonchol.

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Kendrick, J., Chonchol, M. Nontraditional risk factors for cardiovascular disease in patients with chronic kidney disease. Nat Rev Nephrol 4, 672–681 (2008). https://doi.org/10.1038/ncpneph0954

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