Chronic kidney disease detection, staging and treatment in cardiovascular disease prevention
- 10 February 2021
- Vol. 107 (16), 1282-1288
- https://doi.org/10.1136/heartjnl-2020-318004
Abstract
Globally, nearly 10% of the population has chronic kidney disease (CKD), defined as a glomerular filtration rate less than 60 mL/min/1.73 m2 and/or a urinary albumin to creatinine ratio greater than 30 mg/g (3 mg/mmol). Persons with CKD have a substantially high risk of cardiovascular disease. Indeed, most persons with CKD are far more likely to develop a cardiovascular event than to progress to end-stage kidney disease. Although early detection and staging of CKD could help prevent its cardiovascular consequences, current rates of testing for CKD are very low, even among high-risk populations such as persons with diabetes, hypertension and cardiovascular disease. In this review, we first describe the need to test for both estimated glomerular filtration rate and albuminuria among persons at high risk of CKD in order to properly stage CKD and enhance cardiovascular risk stratification. We then discuss how detection and staging for CKD could help prioritise patients at high risk of atherosclerotic cardiovascular disease and heart failure who could derive the largest benefit from cardiovascular preventive interventions. In addition, we discuss the central role of CKD detection and staging in the initiation of cardiorenal preventive therapies, such as the sodium–glucose cotransporter 2 inhibitors, which have shown overwhelming evidence of cardiorenal protection. We conclude by discussing strategies to overcome historical barriers to CKD detection and treatment.Keywords
This publication has 47 references indexed in Scilit:
- Proteinuria and Rate of Change in Kidney Function in a Community-Based PopulationJournal of the American Society of Nephrology, 2013
- Cystatin C versus Creatinine in Determining Risk Based on Kidney FunctionThe New England Journal of Medicine, 2013
- Screening for albuminuria with subsequent screening for hypertension and hypercholesterolaemia identifies subjects in whom treatment is warranted to prevent cardiovascular eventsNephrology Dialysis Transplantation, 2013
- Evaluation of cardiovascular disease burden and therapeutic goal attainment in US adults with chronic kidney disease: an analysis of national health and nutritional examination survey data, 2001–2010BMC Nephrology, 2013
- Estimating Glomerular Filtration Rate from Serum Creatinine and Cystatin CThe New England Journal of Medicine, 2012
- The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference reportKidney International, 2011
- The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trialThe Lancet, 2011
- Renin angiotensin system blockade and cardiovascular outcomes in patients with chronic kidney disease and proteinuria: A meta-analysisAmerican Heart Journal, 2008
- Chronic Kidney Disease and the Risks of Death, Cardiovascular Events, and HospitalizationThe New England Journal of Medicine, 2004
- Angiotensin-Converting Enzyme Inhibitors and Progression of Nondiabetic Renal DiseaseAnnals of Internal Medicine, 2001