Chronic kidney disease carries a higher risk of cardiovascular disease and premature mortality compared to the general population.
Patients with progressive deterioration of renal function have associated traditional cardiovascular risk factors, which explain to some extent the increase in morbidity and mortality. However, other non-traditional risk factors, and especially the development of left ventricular hypertrophy, contribute to magnifying this adverse prognosis.
Strict control of these risk factors such as blood pressure, cholesterol, especially elevated low-density lipoprotein cholesterol (LDL-C), and blood glucose or glycosylated hemoglobin (a more stable indicator), could drastically reduce early cardiovascular events in this population group.
Antihypertensive therapy is the basis of therapeutic management of chronic kidney disease, since strict control of blood pressure is probably the most important measure to delay the progression of kidney disease and prevent cardiovascular morbidity and mortality. The most important parameters are to achieve a reduction in blood pressure to less than 130/80 mmHg and proteinuria to < 0,5 g/24 hours, but also to introduce antiplatelet agents and, if necessary, lipid-lowering and antidiabetic agents.
It is a well-established fact that dyslipidemia plays a role in the development of
vascular disease as in the progression of kidney disease. For this reason,
recommends treatment and control of dyslipidemia in all patients with kidney disease.
Several non-traditional risk factors, such as hyperhomocysteinemia, oxidative stress or elevated inflammatory markers are associated with arteriosclerosis, oxidative stress and inflammation may be the primary mediators that would explain the high prevalence of cardiovascular disease in patients with kidney disease. But there are other important factors, including anemia, which is related to cardiomyopathy, and abnormal calcium-phosphorus metabolism, which is associated with vascular remodeling and loss of vessel elasticity.
When you have kidney failure, important minerals in your body, such as calcium and phosphorus, may become unbalanced, and your vitamin D levels may also decrease, so your bones may lose calcium and become weaker over time. Some calcium and phosphorus may end up in parts of your body where they don't belong, such as your heart and blood vessels. This causes your blood vessels to become stiff and narrow, increasing your chance of having a heart attack. Some medications and a special diet are prescribed to treat these disorders.
Mechanisms of cardiovascular complications in patients with chronic kidney disease
Endothelial dysfunction, inflammation and vascular calcification are key mechanisms that increase both cardiovascular risk and progression of kidney disease. These factors underline the need for comprehensive management that combines attention to both renal and cardiovascular problems. Therefore, the importance of strictly controlling cardiovascular risk factors in patients with kidney disease is emphasized to reduce the associated additional risk.
Around 20% of patients with kidney disease experience arrhythmias, that is, heart rhythm disturbances that can lead to sudden death, especially in those undergoing dialysis. Heart failure also occurs concurrently with chronic kidney disease in at least half of patients. Furthermore, kidney patients often have serious problems with their heart valves.
In any case, as kidney function deteriorates, heart function worsens. Kidney problems age the heart. Hence the importance of preventing cardiovascular disease in the early or intermediate stages of kidney decline.
Therefore, rigorous control of cardiovascular risk factors in patients with chronic kidney disease is associated with a significant reduction in the risk of cardiovascular events, progression of the disease itself and mortality.
By Dr. Yanela Y. Ortega, cardiology specialist at UICAR