Management of Traditional Cardiovascular Risk Factors in CKD: What Are the Data?

Abstract

Patients with non-dialysis-dependent chronic kidney disease (NDD-CKD) are 10 times more likely to die of cardiovascular (CV) diseases than the general population, and dialysis-dependent patients are at even higher risk. Although traditional CV risk factors are highly prevalent in individuals with CKD, these patients were often excluded from studies targeting modification of these risks. Although treatment of hypertension is beneficial in CKD, the best target blood pressure has not been established. Trial data showed that renin-angiotensin-aldosterone blockade may prevent CV events in patients with CKD. The risks of aspirin may equal the benefits in NDD-CKD samples, and there are no trials testing aspirin in dialysis-dependent patients. Lipid-lowering therapy improves CV outcomes in NDD-CKD, but not in dialysis-dependent patients. Strict glycemic control prevents CV events in nonalbuminuric individuals, but showed no benefit in those with baseline albuminuria with albumin excretion > 300mg/g, and there are no data in dialysis-dependent patients. Data for lifestyle modifications, such as weight loss, physical activity, and smoking cessation, are mostly observational and extrapolated from non-CKD samples. This comprehensive review summarizes the best existing evidence and current clinical guidelines for modification of traditional risk factors for the prevention of CV events in patients with CKD and identifies knowledge gaps.

Keywords: Chronic kidney disease (CKD); RAAS blockade; albuminuria; aspirin; cardiovascular disease (CVD); cardiovascular risk; dialysis; hemodialysis (HD); hyperlipidemia; hypertension; lifestyle interventions; modifiable risk factor; review; smoking; statin; weight loss.

Figure 1. Evidence-based modification of traditional risk factors to mitigate CV disease and current knowledge gaps

Abbreviations: BP, blood pressure; CKD-5D, dialysis-dependent chronic kidney disease; CV, cardiovascular; NDD-CKD, non-dialysis-dependent chronic kidney disease; RAAS, renin angiotensin aldosterone system; UF, ultrafiltration