Special Lancet Series Explores Global Burden of Kidney Disease CV Disease More Frequent, But Undertreated in Chronic Kidney Disease Patients

Cardiovascular disease is more frequent and severe, is often not recognized, and is often undertreated in patients with chronic kidney disease, according to a paper  published as part of a new Lancet series focused on the global burden of kidney disease.

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The paper, one of six, highlights the many epidemiological studies that have confirmed an association between cardiovascular disease and chronic kidney disease – in part because the two diseases share common risk factors like smoking, obesity, hypertension, hypercholesterolaemia, and diabetes. In addition, the authors note, "mechanisms specific to chronic kidney disease promote vascular disease and, therefore, substantially increase the burden of cardiovascular disease in individuals with chronic kidney disease."

Despite the association between the two diseases, the authors point out that cardiovascular disease is often underdiagnosed and undertreated in this group of patients. "The strong causal association between chronic kidney disease and cardiovascular risk implies that to prevent progression of chronic kidney disease is, by definition, to prevent cardiovascular disease," they suggest. "To that end we call for action."

According to the authors, there are at least two approaches to preventing cardiovascular events in chronic kidney disease patients that should be further investigated. First, they suggest that treatment should be started in the early stages of chronic kidney disease. "Screening for albuminuria and treatment with angiotensin-converting-enzyme inhibitors in patients who have increased albuminuria might be a cost-effective approach to prevent cardiovascular events and kidney failure," they note, "especially in people at high risk of developing chronic kidney disease, such as those with diabetes, hypertension, or old age."

The second approach would require intensified, multifactorial interventions in patients at later stages in chronic kidney disease. According to the authors, studies have shown benefits from "multimodal treatment that included strict glucose management, antihypertensive agents, aspirin, and lifestyle interventions (smoking cessation, increased physical activity, and dietary changes) compared with standard care according to national guidelines."

Moving forward, the authors suggest that patients with chronic kidney disease be acknowledged as a group at high risk of cardiovascular disease. "This view should be taken into account when guidelines are developed and research priorities are defined. Trials dedicated to prevention of cardiovascular disease in patients with chronic kidney disease are urgently needed," they said.

Other papers in the Lancet series focus on the evolving importance of kidney disease; the increasing global concern around acute kidney injury; global differences in the burden of kidney disease;  and the importance of maternal and fetal health in preventing kidney disease in later life.  In addition, the final paper in the series looks at "the new and exciting developments in fields such as pharmacology, genetic, or bioengineering" that can help the nephrology community close the divide between high-income and low-income countries in the diagnosis and treatment of kidney disease over the next decade.

Clinical Topics: Prevention, Hypertension, Smoking

Keywords: Acute Kidney Injury, Risk Factors, Smoking, Glucose, Kidney Diseases, Epidemiologic Studies, Cardiovascular Diseases, Motor Activity, Obesity, Hypertension, Diabetes Mellitus, Renal Insufficiency, Chronic, Smoking Cessation

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