Prevalence of cardiovascular damage in early renal disease.

There is a large burden of cardiovascular disease in early renal disease due to multiple risk factors. Although left ventricular hypertrophy (LVH) is prevalent early in the process of progressive renal decline, it is associated with a number of modifiable risk factors (e.g. anaemia and systolic blood pressure (BP)). More importantly, treatment of modifiable risk factors in renal disease can delay progression. It is important to define anaemia physiologically and to remember that it is also associated with a number of cardiovascular risk factors that may/may not be independent of each other. In a recent prospective, multicentre Canadian study of early renal disease patients prior to dialysis (n=446), the baseline prevalence of LVH increased both with decreasing renal function and decreasing haemoglobin (Hb) levels. Notably, Hb levels within current guideline target levels were still associated with a very high degree of LVH. Over a 12-month period, only a decrease in Hb and an increase in systolic BP, and baseline left ventricular mass index (LVMI) predicted left ventricular growth. Patients whose cardiac symptoms progressed over 12 months were those who experienced a significant fall in BP and a significant increase in LVMI during that time. In the future, steps are needed to ensure early identification of both renal disease and specific risk factors. Recognizing modifiable risk factors and addressing them early in the course of renal disease will facilitate the improvement of patient outcomes.