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(Circulation. 2007;116:85-97.)
© 2007 American Heart Association, Inc.

Cardiovascular Involvement in General Medical Conditions

Chronic Kidney Disease

Effects on the Cardiovascular System

Ernesto L. Schiffrin, MD, PhD, FRSC, FRCPC; Mark L. Lipman, MD, FRCPC; Johannes F.E. Mann, MD

From the Department of Medicine (E.L.S., M.L.L.), Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Quebec, Canada; and the Department of Nephrology and Hypertension (J.F.E.M.), Schwabing General Hospital, Ludwig Maximilians University, Munich, Germany.

Correspondence to Ernesto L. Schiffrin, MD, PhD, FRSC, FRCPC, Sir Mortimer B. Davis Jewish General Hospital, B-127, 3755 Côte Ste-Catherine Rd, Montreal, Quebec, Canada H3T 1E2. E-mail ernesto.schiffrin{at}mcgill.ca

Accelerated cardiovascular disease is a frequent complication of renal disease. Chronic kidney disease promotes hypertension and dyslipidemia, which in turn can contribute to the progression of renal failure. Furthermore, diabetic nephropathy is the leading cause of renal failure in developed countries. Together, hypertension, dyslipidemia, and diabetes are major risk factors for the development of endothelial dysfunction and progression of atherosclerosis. Inflammatory mediators are often elevated and the renin-angiotensin system is frequently activated in chronic kidney disease, which likely contributes through enhanced production of reactive oxygen species to the accelerated atherosclerosis observed in chronic kidney disease. Promoters of calcification are increased and inhibitors of calcification are reduced, which favors metastatic vascular calcification, an important participant in vascular injury associated with end-stage renal disease. Accelerated atherosclerosis will then lead to increased prevalence of coronary artery disease, heart failure, stroke, and peripheral arterial disease. Consequently, subjects with chronic renal failure are exposed to increased morbidity and mortality as a result of cardiovascular events. Prevention and treatment of cardiovascular disease are major considerations in the management of individuals with chronic kidney disease.

Key Words: atherosclerosis • hypertension • kidney • vasculature

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