Cardiovascular Mortality Risk in Chronic Kidney Disease

Abstract

The National Kidney Foundation, American Heart Association, and the Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure have classified the presence of chronic kidney disease as a cardiovascular risk factor.^1-3 Chronic kidney disease is associated with substantially increased risk for cardiovascular disease morbidity and mortality, independent of traditional cardiovascular risk factors such as diabetes, hypertension, lipoprotein levels, and tobacco use.^1,4-6 In addition, certain novel cardiovascular risk factors are more prevalent in persons with chronic kidney disease, including elevated inflammatory and prothrombotic factors (C-reactive protein [CRP], fibrinogen, interleukin 6 [IL-6], and factor VIII), and lipoprotein(a) (Lp[a]), and decreased hemoglobin levels. These novel risk factors have been discussed as potential mechanisms for the elevated cardiovascular risk of chronickidney disease,^7-9 but few studies have evaluated their association with cardiovascular events in persons with chronic kidney disease or compared the strength of association of traditional and novel cardiovascular risk factors. Though the National Institutes of Health and the National Kidney Foundation have prioritized the reduction of cardiovascular disease burden in persons with chronic kidney disease, prevention efforts will first require an in-depth understanding of the determinants of cardiovascular risk in persons with chronic kidney disease.¹⁰