The burden of cardiovascular disease in patients with chronic kidney disease and in end-stage renal disease.

Patients who reach the end-stage phase of renal disease (ESRD) display an exceedingly high risk for cardiovascular (CV) complications. However it is still unclear whether in patients with chronic kidney disease (CKD) a critical glomerular filtration rate (GFR) threshold exists below which CV risk starts to rise. Analyses based on a medical database indicate that starting from the lower limit of the normal range (60 ml/min) a 30-ml/min GFR loss entails a doubling in the CV risk. In contrast, in population-based studies like the Atherosclerosis Risk in the Community (ARIC), the risk excess of stage 3 CKD is much lower, being about 30%. This discrepancy indicates that analyses based on medical databases provide an inflated estimate of the population risk for CV events associated with CKD. However, given the high prevalence of CKD at population level (about 8%-10%), a 30% increase in the risk of CV events would still have enormous public health implications. A considerable proportion of patients with CKD and occult or overt CV disease still remain largely undertreated. Multiple interventions on the multiple, modifiable risk factors of CKD at population and hospital level should be deployed if we are to curb the burden of CV sequelae of the CKD epidemics.