The Cardio-Kidney Patient: Epidemiology, Clinical Characteristics and Therapy

Abstract

Patients with chronic kidney disease (CKD) are at high risk to develop cardiovascular disease with its manifestations coronary artery disease, heart failure, arrhythmias, and sudden cardiac death. In addition, the presence of CKD has a major impact on the prognosis of patients with cardiovascular disease, leading to an increased morbidity and mortality if both comorbidities are present. Therapeutic options including medical therapy and interventional treatment are often limited in patients with advanced CKD, and in most cardiovascular outcome trials, patients with advanced CKD have been excluded. Thus, in many patients, treatment strategies for cardiovascular disease need to be extrapolated from trials conducted in patients without CKD. The current article summarizes the epidemiology, clinical presentation, and treatment options for the most prevalent manifestations of cardiovascular disease in CKD and discusses the currently available treatment options to reduce morbidity and mortality in this high-risk population.

Keywords: cardiovascular diseases; coronary artery disease; heart failure; prognosis; renal insufficiency, chronic.

Figure 1.

Simplified scheme depicting the interaction of cardiovascular disease and chronic kidney disease. RAAS indicates renin-angiotensin-aldosterone; and SNS, sympathetic nerve system.

Figure 2.

Reduction of cardiorenal risk in patients with chronic kidney disease (CKD). ACE indicates angiotensin-converting enzyme; ARB, angiotensin-II receptor blocker; CV, cardiovascular; Hba1c, glycated hemoglobin; HHF, hospitalization for heart failure; HR, hazard ratio; LDL, low-density lipoprotein; OR, odds ratio; SGLT2, sodium-glucose cotransporter 2; and T2D, type 2 diabetes mellitus. ¹Fatal or nonfatal myocardial infarction, stroke, and heart failure; cardiovascular death. ²Doubling of serum creatinine level, 50% decline in eGFR, or end-stage kidney disease (ESKD). ³All SGLT2 inhibitor CVOTs (cardiovascular outcome trials). ⁴Only SGLT2 inhibitor trials in patients with CKD. ⁵Sustained decrease in eGFR (estimated glomerular filtration rate) (≥50%) from randomization, a sustained low eGFR, end-stage kidney disease, or death from kidney failure. ⁶Kidney failure (ESKD or an eGFR <15 mL/min per 1.73 m²), sustained ≥57% decrease in eGFR from baseline, or renal death. ⁷ESKD or an eGFR <15 mL/min per 1.73 m².