Why Do Chronic Kidney Disease Patients Have Risk for Cardiovascular Disease? How To Treat
Cardiovascular Disease (CVD) is the leading cause of death in patients with Chronic Kidney Disease (CKD), both non-dialysis CKD patients and dialysis or kidney transplant patients. Reasonable management of CVD in CKD patients have important clinical significance. Recently, professor Yang Hongtao from Peking Tung Shin Tang Hospital of Traditional Chinese Medicine shared the following contents on “Development in the Prevention and Treatment of CKD and CVD”.
Why do CKD patients have risk for CVD?
CKD patients have a cluster of risk factors to increase the risk of cardiovascular diseases including traditional risk factors and non-traditional risk factors. The study showed that among people aged 66 or over, CVD prevalence was 65.8% in patients with CKD and 31.9% in patients without CKD. And CVD can seriously threatening the life of CKD patients and reduce the survival rate, which makes CKD patients be at risk of both end stage renal disease and CVD. And a large number of CKD patients die of CVD complications before they develop ESRD. According to the data, about 50% of ESRD patients died of CVD.
Effect of kidney function on CVD
Data showed that EGFR < 60 ml/min/1.73m2 is an independent risk factor for all-cause mortality and cardiovascular death, and proteinuria is closely related to all-cause mortality and cardiovascular death risk. After treatment, all-cause death rate and cardiovascular mortality increased with proteinuria increasing and eGFR decreasing.
Effect of blood pressure on CVD
Changes in endothelial function, increased blood volume, sympathetic nerve activity, and RAAS activity, increased parathyroid hormone, decreased prostaglandin/bradykinin, and the application of EPO in CKD patients can increase blood pressure, which in turn can lead to further damage of renal structure and accelerate the progression of renal disease. A follow-up study of 7.4 years showed that with the development of hypertension, the risk of cardiovascular disease increased in patients with CKD.
Effect of anemia on CVD
Anemia occurs in both cardiovascular diseases and chronic kidney disease. Once anemia occurs and cardiac workload increases, it causes left ventricular hypertrophy, which eventually makes cardiac function poorer, then damage kidney function and form a vicious circle.
Effect of CKD-MBD(mineral and bone disorder) on CVD
CKD-minera and bone disorder (MBD) are common complications in the progression of CKD. Two or more of CKD-MBD biochemical indexes (calcium, phosphorus and PTH) beyond the target range can significantly increase the risk of clinical adverse events. For every 1 mg/dl increase in serum phosphorus, the risk of all-cause mortality increased by 18% and the risk of cardiovascular mortality increased by 10%. In addition, high iPTH can seriously damage multiple target organs. The increase of iPTH is closely related to the risk of death of patients, and the risk of cardiovascular death also presents a similar trend, which also increases with the increase of PTH.
How do CKD patients treat CVD?
In order to reduce the risk of CVD, CKD patients should give individualized management according to CKD stages or renal replacement therapy patterns. Non-pharmacological interventions are used to manage lifestyle factors such as non-smoking, sodium restriction, obesity management, and exercise, etc. Besides, active management of cardiovascular risk factors, such as control of dyslipidemia, correction of anemia, control of blood pressure, correction of calcium and phosphorus metabolic disorders, control of blood glucose and anti-inflammatory therapy, can help the risk of reduce cardiovascular disease.
Control blood pressure
Controlling hypertension is a major therapeutic goal to reduce the risk of CKD progression. Studies have shown that systolic blood pressure was reduced by an average of 20 mmHg, the relative risk of renal end-point events was reduced by 47%, and the risk of cardiovascular mortality was reduced by 39%. For every 4.5/2.3 mmHg reduction in blood pressure, the risk of cardiovascular events, all-cause death, and cardiovascular death in hemodialysis patients with hypertension was significantly reduced by 29%, 20%, and 29%. Aggressive blood pressure lowering therapy can reduce the risk of renal failure in CKD patients, improve the risk of ESRD death and let more cardiovascular disease patients get benefits.
Most patients with CKD suffer from varied degrees of anemia, and active management of anemia can improve the prognosis. The KDIGO guidelines recommend that the Hb level in CKD patients should be controlled at > 11.0g /dl, while in adult CKD patients, ESAs treatment is not recommended to maintain Hb> 11.5g /dl. The consensus of experts in China suggests that the Hb level of CKD patients should be controlled at > 11.0g /dl, but Hb>13 g/dl is not recommended. Drug dose adjustment should be conducted according to patients' age, dialysis mode, duration of dialysis, duration of ESA treatment, physiological needs and whether patients are combined with other cardiovascular diseases.
Studies have shown that phosphate binders improve survival and reduce all-cause mortality and cardiovascular death risk in dialysis patients.
***Please seek professional medical advise for the diagnosis or treatment of any ailment, disease or medical condition. This article is not intended to be a substitute for the advice of a licensed medical professional.***