IMR Press / RCM / Volume 20 / Issue 4 / DOI: 10.31083/j.rcm.2019.04.548
Open Access Review
Epidemiology of cardiovascular risk in chronic kidney disease patients: the real silent killer
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1 Department of Health Sciences, Renal Unit, "Magna Graecia" University, 88100 Catanzaro, Italy
2 Department of Scienze Mediche e Chirurgiche Avanzate, Renal Unit, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
3 Interuniversity Center of Phlebolymphology (CIFL), “Magna Graecia” University, 88100 Catanzaro, Italy
Rev. Cardiovasc. Med. 2019 , 20(4), 209–220; https://doi.org/10.31083/j.rcm.2019.04.548
Submitted: 6 August 2019 | Accepted: 16 October 2019 | Published: 30 December 2019
Abstract

Chronic kidney disease is a growing public health problem, as its prevalence and incidence have almost doubled over the last three decades. Chronic kidney disease is defined as the presence of an estimated glomerular filtration rate < 60 ml/min/1.73 m2 and/or proteinuria ≥ 0.150 g/24 h. It has been demonstrated that both proteinuria and reduction in estimated glomerular filtration rate can predict the development of fatal and non-fatal cardiovascular events, regardless of traditional cardiovascular risk factors, namely blood pressure, smoking habit, cholesterol, age, gender. This relationship is found in the general population, high-risk cohorts and in patients referred to Nephrologists (tertiary care). The accuracy by which proteinuria or estimated glomerular filtration rate can predict these events, exceeds that obtained by the combination of all the other traditional risk factors. These important findings have led to chronic kidney disease being considered as a cardiovascular risk equivalent. Although this needs further investigation, a great effort has been made to reduce the cardiovascular risk in chronic kidney disease patients. Indeed, many clinical trials have been carried-out testing the effect of antihypertensive, proteinuria-lowering, lipid-lowering and hypoglycemic agents on cardiovascular risk protection. All these trials reduced, but did not eliminate, the overall cardiovascular risk. Future studies should be undertaken to identify high cardiovascular risk patients and novel therapeutic targets for cardiovascular protection in chronic kidney disease patients.

Keywords
Epidemiology
cardiovascular risk
blood pressure
chronic kidney disease
statins
proteinuria
albuminuria
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