| Literature DB >> 31686830 |
Gayatri Lessey1, Konstantinos Stavropoulos1,2, Vasilios Papademetriou1,2.
Abstract
Chronic kidney disease (CKD) has become a major public health problem in the USA and worldwide. A large majority of patients with CKD have mild to moderate disease and microalbuminuria. It has increasingly been noted that patients with CKD have a significantly higher risk of cardiovascular outcomes compared to patients with normal kidney function. Many studies have shown increased risk beginning at stage 3 CKD but risk has been elevated in patients with milder degrees of kidney dysfunction in some studies. This risk may be better predicted by the degree of albuminuria in the earlier stages of CKD. Data addressing interventions to improve outcomes in patients with mild to moderate CKD are scarce. In this paper, we examined data and post hoc analyses from the ORIGIN and ACCORD trials. Data indicate that intensive treatment of diabetes in patients with CKD actually may result in adverse outcomes. The mechanism by which CKD results in increased cardiovascular risk is not clear. Patients with CKD frequently have the traditional risk factors that cause cardiovascular disease and there are mechanisms that are unique to CKD that promote the development of cardiovascular disease. In this article, we describe in some detail traditional, newer and novel risk factors that play a role in the development of CKD and heart disease.Entities:
Keywords: CAD; CKD; cardiovascular mortality; diabetes mellitus
Mesh:
Substances:
Year: 2019 PMID: 31686830 PMCID: PMC6709811 DOI: 10.2147/VHRM.S203925
Source DB: PubMed Journal: Vasc Health Risk Manag ISSN: 1176-6344
Figure 1Pathophysiological mechanisms involved in the development of cardiovascular disease in CKD. Factors that have bidirectional action and may affect both kidney and cardiac function are labeled with #.Abbreviations: CCR7, chemokine receptor 7; CKD, Chronic Kidney Disease.
Summary of the most important clinical studies assessing cardiovascular risk and renal outcomes in patients with T2D and CKD other than ORIGIN, ACCORD, and EMPA-REG
| Study | Number of participants | Comparators | Outcome |
|---|---|---|---|
| ABCD [45] | 480 normotensive patients with diabetes mellitus | Intensive decrease in DBP vs target for DBP of 80–89 mmHg | −15 vs 8 patients reverted from microalbuminuria to normoalbuminuria* |
| IDNT [46] | 590 patients with hypertension, diabetes and microalbuminuria | Irbesartan 150 or 300 mg vs placebo | Time of onset of diabetic nephropathy: HR: 0.3 (95%CI: 0.14–0.61)* |
| RENAAL [47] | 1,513 patients with hypertension, diabetes and nephropathy | Baseline SBP: 140–159 mmHg vs <130 mmHg | Risk for ESRD of death HR: 0.62* |
| UKPDS [48] | 5,097 patients with diabetes | After 10 years of follow-up | -Patients with nephropathy had an annual death rate of 19.2%* |
| VA Nephron [49] | 1,449 with diabetes mellitus, macroalbuminuria and eGFR 30–89 mL/min/1.73 m2 | Losartan with lisinopril vs losartan with placebo | -Mortallity HR: 1.04 (95%CI: 0.73–1.49) |
Abbreviations: T2D, type 2 diabetes; CKD, chronic kidney disease; DBP, diastolic blood pressure; SBP, systolic blood pressure; ESRD, end-stage renal disease; eGFR, estimated glomerular filtration rate.