Managing Cardiovascular Disease in Patients With Chronic Kidney Disease

Martin H. de Borst, MD, PhD


July 30, 2020

Cardiovascular disease (CVD) and chronic kidney disease (CKD) have a complex and close relationship. Recent studies report that patients who require dialysis have a 50-fold higher risk for death from CVD than the general population. In the United States, the prevalence of CVD in patients with CKD approaches 63%, compared with 5.8% in people without CKD.

Overactivity of the renin-angiotensin-aldosterone system (RAAS), a complex neurohormonal pathway involved in both renal and cardiovascular function, can produce a wide range of harmful effects on the heart, including fibrosis, inflammation, and remodeling of the myocardium. Therapies targeting RAAS activation are recommended in the management of cardiovascular risk in patients with CKD. In the presence of reduced renal function, however, medications that suppress RAAS activity can increase the risk for hyperkalemia, leaving unanswered questions about initiation and dosing.

In this ReCAP, Dr Martin H. de Borst, from University Medical Center Groningen in the Netherlands, discusses strategies to control RAAS activity and manage cardiovascular disease in patients with CKD.


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