Chronic Kidney Disease and Cardiovascular Outcomes

Cardiovascular disease (CVD) is the primary cause of mortality in patients with chronic kidney disease (CKD). Cardiorenal syndromes encompass several disorders of both the heart and the kidneys in which dysfunction in one organ induces dysfunction in the other organ. Multiple biomarkers are being studied to determine risks and outcomes in patients experiencing worsening kidney function with CKD, and recent years have yielded a number of advances aimed at limiting CVD and death in patients with cardiorenal syndromes. Renin-angiotensin-aldosterone system inhibitor medications are the foundation of lowering proteinuria, controlling hypertension, and limiting cardiovascular complications in those with CKD. Sodium-glucose cotransporter inhibitor medications have become a new cornerstone of cardioprotection in CKD. Although 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) provide benefits to patients with CKD, they are controversial for outcomes in patients with end-stage kidney disease. Controlling blood pressure to a goal of <130/80 mm Hg is recommended in those with CKD. Smoking cessation, exercise, and a low salt diet have been associated with better outcomes in patients with CKD. Second-generation mineralocorticoid antagonists and endothelin antagonists are being studied as new classes for the management of CVD in CKD. This chapter provides an overview of the complex inter-relationship between CKD and CVD, and describes the current landscape of cardiovascular outcomes trials involving therapeutic agents used in the management of CKD and CVD.