CKD increases the risks of both fatal and non-fatal cardiovascular events. Patients with CKD who suffer a cardiovascular event far worse than patients without CKD. At the population level these increased risks can be observed even in patients with low levels of proteinuria and preserved renal function. The risks increase with declining renal function and worsening proteinuria. Standard cardiovascular risk prediction tools, such as Framingham tables, significantly under estimate the risks of cardiovascular disease in patients with CKD.
These observations reinforce the importance of trying to control the modifiable cardiovascular risk factors in patients with CKD. Such approaches may include:
- Smoking cessation
- Weight loss
- Regular aerobic exercise
- Limiting salt intake
Control of hypertension
- To maxima of 140/90 or 130/80 according to absence/presence of proteinuria or diabetes (see hypertension)
Lipid lowering therapies
- Offer Atorvastatin 20 mg for the primary or secondary prevention of cardiovascular disease in patients with CKD, irrespective of their serum lipid levels
- Increase the dose if there is <40% reduction in non-HDL cholesterol and eGFR is > 30 ml/min/1.73m2, particularly for secondary prevention of cardiovascular disease
- Offer antiplatelet drugs to people with CKD for the secondary prevention of cardiovascular disease. Be aware of the increased risk of bleeding in this group.
Information for patients
Patients with CKD are more likely to develop heart disease or other diseases of the blood vessels such as strokes than they are kidney failure. A number of things can be done to minimise these risks including lifestyle changes and medications.