General Strategies In Retardation Of Chronic Kidney Disease

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Cardiovascular Disease in Chronic Kidney Disease
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Cardiovascular disease (CVD) risk

• dramatically increased in patients on RRT -
  recognized since 1970s
• (Lindner, NEJM 1974)
• Magnitude of the risk is more clearly quantified
  in recent studies
• (Foley et al, KI 1998)
• Commonest cause of death in dialysis population

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Cardiovascular disease (CVD) risk

• Minor renal dysfunction is an independent risk
  factor for CVD
• Only recently both the consistency and magnitude
  of CV risk associated with even minor renal
  dysfunction has been fully appreciated

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Cardiovascular mortality in dialysis patients is
10 20 times higher than in the general
population
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Prevalence of CVD in Early Kidney
DiseaseFramingham Heart Study 1977-1993
Mild renal insufficiency Man Cr 136-265
umol/l Woman Cr 120-265 umol/l
Culleton BF, KI 1999(56)2214
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Cardiovascular survival according to tertiles of
GFR
Hoorn Study
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Framingham Heart Study Prevalence of risk
factors by renal f(x) category
Traditional risk factor are more common in
patients with CKD
BMIgt27.3


HDL-chol lt0.9


Total cholgt 6.2

Current smoker

diabetes


hypertension

Normal SCr
MRI
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CVD risk factors in CKD

• Traditional
• (Framingham Study)
• Age
• Male
• Family history
• Hypertension
• LVH
• High LDL, low HDL
• Diabetes mellitus
• Tobacco use
• Physical inactivity
• menopause

• CKD related
• GFR
• Proteinuria
• RAS
• ECF volume overload
• Abnormal Ca/PO4
• PTH
• Anaemia
• High TG
• High homocysteine
• Inflammation
• Oxidative stress
• High Lp (a)
• Thrombogenic factors
• malnutrition

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CKD related risk factors

• Modifiable
• GFR
• Proteinuria
• RAS
• ECF volume overload
• Abnormal Ca/PO4
• PTH
• Anaemia
• High TG
• High homocysteine

• Non-modifiable
• Inflammation
• Oxidative stress
• High Lp (a)
• Thrombogenic factors
• malnutrition

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Summary

• All CKD patients should be considered as high
  risk group of having CVD, irrespective of
  aetiology and severity of renal impairment.
• Early screening and recognition of risk factors
  of CVD are important in the management of CKD.
• Early interventions may reduce the burden of CVD
  in CKD patients

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Goals of CKD management

• BP control
• RAS blockade
• Proteinuria reduction
• Glycaemic control
• Lipidaemic control
• Smoking cessation
• Protein restriction
• Avoid nephrotoxic agents