Chronic kidney disease as independent risk factor for cardiovascular disease
Omar Al Dhaybi, MD, and George Bakris, MD of the ASH Comprehensive Hypertension Center in Chicago report on chronic kidney disease as independent risk factor for cardiovascular disease.
Chronic kidney disease, defined as an estimated glomerular filtration rate of less than 60 mL/min/1,73 m2, is a broad public health problem. The mean global prevalence of CKD is estimated to be 13.4%. This percentage encompasses the estimated prevalence of diabetes, which is close to 8.2%. Diabetes was considered a coronary artery disease risk equivalent, but subsequent data have not supported this contention. Conversely, CKD is associated with higher all-cause mortality rates compared to previous myocardial infarction. Thus, patients with a coronary heart disease equivalent should have a risk for a coronary event comparable to those with a history of myocardial infarction. Most of the coronary risk in patients with CKD is driven by longstanding exposure to traditional cardiovascular risk factors.
Nonetheless, CKD is associated with increased all cause mortality, and remains a well-established, independent risk factor for cardiovascular death, and this is supported by extensive clinical data. Older studies that failed to demonstrate an association between CKD and cardiovascular events were limited by non-uniform definitions of kidney disease, and the inclusion of small number of patients with actual CKD, limiting the statistical power to identify factual associations.
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