Chronic kidney disease detection, staging and treatment in cardiovascular disease prevention

Globally, nearly 10% of the population has chronic kidney disease (CKD), defined as a glomerular filtration rate less than 60 mL/min/1.73 m2 and/or a urinary albumin to creatinine ratio greater than 30 mg/g (3 mg/mmol). Persons with CKD have a substantially high risk of cardiovascular disease. Indee...

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Bibliographic Details
Published in:Heart (British Cardiac Society) Vol. 107; no. 16; pp. 1282 - 1288
Main Authors: Lamprea-Montealegre, Julio Alejandro, Shlipak, Michael G, Estrella, Michelle M
Format: Journal Article
Language:English
Published: England BMJ Publishing Group Ltd and British Cardiovascular Society 01.08.2021
BMJ Publishing Group LTD
Subjects:
biomarkers
Cardiovascular disease
Clinical medicine
Collaboration
coronary artery disease
Creatinine
Diabetes
Disease prevention
Epidemiology
Hypertension
Kidney diseases
Mortality
Population
Review
Urine
United States > US
San Francisco California
California
coronary artery disease
epidemiology
biomarkers
ISSN:1355-6037, 1468-201X, 1468-201X
Online Access:Get full text
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Summary:Globally, nearly 10% of the population has chronic kidney disease (CKD), defined as a glomerular filtration rate less than 60 mL/min/1.73 m2 and/or a urinary albumin to creatinine ratio greater than 30 mg/g (3 mg/mmol). Persons with CKD have a substantially high risk of cardiovascular disease. Indeed, most persons with CKD are far more likely to develop a cardiovascular event than to progress to end-stage kidney disease. Although early detection and staging of CKD could help prevent its cardiovascular consequences, current rates of testing for CKD are very low, even among high-risk populations such as persons with diabetes, hypertension and cardiovascular disease. In this review, we first describe the need to test for both estimated glomerular filtration rate and albuminuria among persons at high risk of CKD in order to properly stage CKD and enhance cardiovascular risk stratification. We then discuss how detection and staging for CKD could help prioritise patients at high risk of atherosclerotic cardiovascular disease and heart failure who could derive the largest benefit from cardiovascular preventive interventions. In addition, we discuss the central role of CKD detection and staging in the initiation of cardiorenal preventive therapies, such as the sodium–glucose cotransporter 2 inhibitors, which have shown overwhelming evidence of cardiorenal protection. We conclude by discussing strategies to overcome historical barriers to CKD detection and treatment.
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ISSN:1355-6037
1468-201X
1468-201X
DOI:10.1136/heartjnl-2020-318004