Diabetic patients with chronic kidney disease: Non-invasive assessment of cardiovascular risk

Abstract

The prevalence and burden of diabetes mellitus and chronic kidney disease on global health and socioeconomic development is already heavy and still rising. Diabetes mellitus by itself is linked to adverse cardiovascular events, and the presence of concomitant chronic kidney disease further amplifies cardiovascular risk. The culmination of traditional (male gender, smoking, advanced age, obesity, arterial hypertension and dyslipidemia) and non-traditional risk factors (anemia, inflammation, proteinuria, volume overload, mineral metabolism abnormalities, oxidative stress, etc.) contributes to advanced atherosclerosis and increased cardiovascular risk. To decrease the morbidity and mortality of these patients due to cardiovascular causes, timely and efficient cardiovascular risk assessment is of huge importance. Cardiovascular risk assessment can be based on laboratory parameters, imaging techniques, arterial stiffness parameters, ankle-brachial index and 24 h blood pressure measurements. Newer methods include epigenetic markers, soluble adhesion molecules, cytokines and markers of oxidative stress. In this review, the authors present several non-invasive methods of cardiovascular risk assessment in patients with diabetes mellitus and chronic kidney disease.

Keywords: Atherogenesis; Atherosclerosis; Cardiovascular risk; Chronic kidney disease; Diabetes complications; Diabetes mellitus.

Figure 1

Non-invasive assessment of cardiovascular risk in patients with diabetes mellitus and chronic kidney disease. GFR: Glomerular filtration rate; CKD-MBD: Chronic kidney disease mineral bone disorder; hsCRP: High sensitivity C-reactive protein; sVCAM-1: Soluble vascular cell adhesion molecule-1; sICAM-1: Soluble intercellular adhesion molecule-1; IL-1:Interleukin-1; IL-6: Interleukin-6; IL-18: Interleukin-18; TNF-α: Tumor necrosis factor-α; ABPM: Ambulatory blood pressure measurements; BP: Blood pressure; ABI: Ankle-brachial index; cfPWV: Carotid-femoral pulse wave velocity; SEVR: Subendocardial viability ratio; AIx: Augmentation index; AIx@75: AIx adjusted for heart rate 75/min; ED: Ejection duration; AP: Augmentation pressure; PP: Pulse pressure; CTA: Computed tomography angiography; MRI: Magnetic resonance imaging; lncRNAs: Long non-coding ribonucleic acids; miRNAs: Micro-ribonucleic acids.