Epidemiology

Internal medicine

Albuminuria

Heart failure

Coronary artery disease

Disease

Stroke (engine)

Population

Diabetes mellitus

Endocrinology

Engineering

Cardiology

Intensive care medicine

Kidney disease

Medicine

Mechanical engineering

Environmental health

Nature Reviews Nephrology

Chronic kidney disease (CKD) is defined by a low glomerular filtration rate or high albuminuria, and affects 15–20% of adults globally. CKD increases the risk of various adverse outcomes, but cardiovascular disease (CVD) is of particular relevance because it is the leading cause of death in this clinical population. CKD is associated with several CVD outcomes, including coronary heart disease, stroke, peripheral artery disease, arrhythmias, heart failure and venous thrombosis. Notably, CKD is particularly strongly associated with severe CVD outcomes such as CVD mortality, heart failure and lower extremity amputations. This broad impact of CKD on the cardiovascular system probably reflects the involvement of several pathophysiological mechanisms that link CKD to CVD development — shared risk factors (for example, diabetes and hypertension), changes in bone mineral metabolism, anaemia, volume overload, inflammation and the presence of uraemic toxins. Understanding the status of CKD is crucial for appropriate CVD risk prediction in CKD populations. However, major clinical guidelines are not consistent in their incorporation of CKD measures for CVD risk prediction. Mitigating CVD risk in patients with CKD effectively requires multidisciplinary care that involves nephrologists, cardiologists and other health professionals, as well as further work to address current research and implementation gaps. Chronic kidney disease (CKD) is associated with an elevated risk of cardiovascular disease (CVD). Here, the authors examine CKD-associated risk factors for CVD and consider the prediction and management of CVD risk in patients with CKD, including research and implementation gaps.

Epidemiology and risk of cardiovascular disease in populations with chronic kidney disease