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Renal disease: a common and a silent killer

Nature Clinical Practice Cardiovascular Medicine volume 5, pages S27–S35 (2008)Cite this article

Abstract

Cardiovascular risk profiling and therapy have traditionally been based on established risk factors, such as age, smoking, sex, hypertension, dyslipidemia, body weight, and diabetes mellitus. Despite optimum therapy, cardiovascular mortality and morbidity remain high. Attention is being devoted, therefore, to identifying new risk factors that can also be used as therapeutic targets. Renal dysfunction manifesting as low glomerular filtration rate, albuminuria, or anemia is a strong risk factor for cardiovascular disease and is prevalent in the general population and among patients with cardiovascular disease. Epidemiological data suggest that 10–11% of the general population have low glomerular filtration rates, 5–7% have increased urinary albumin excretion, and 5–10% have anemia. Each of these features represents an independent but additive cardiovascular risk. Treatments for all these indications can reduce cardiovascular mortality and morbidity as well as renal risk. Such findings suggest that treatment should be directed towards improving renal function in order to achieve optimum cardiovascular benefit. Such a strategy would offer the possibility of multiorgan therapy in diseases characterized by multiorgan impairment, such as type 2 diabetes. I present the evidence that renal dysfunction is a common and powerful cardiovascular risk factor and that treatment strategies intervening in the renin–angiotensin–aldosterone system can be used to target albuminuria and reduce cardiovascular and renal risk.

Key Points

  • Increasingly, data show that renal dysfunction is a strong predictor of cardiovascular mortality and morbidity in the general population and among patients with cardiovascular or renal disease, and that cardiovascular disease has an adverse effect on renal function

  • The three main manifestations of renal dysfunction—low glomerular filtration rate, microalbuminuria, and anemia—have independent, additive effects on the risk of renal and cardiovascular disease progression

  • Therapies acting on the renin–angiotensin–aldosterone system have been shown to exert benefits beyond blood pressure reduction in relation to cardiovascular and renal endpoints

  • Patients with renal impairment have frequently been excluded from studies of treatment strategies aimed at the renin–angiotensin–aldosterone system, although growing evidence suggests they are appropriate candidates for these therapies

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Figure 1: Relationships between renal dysfunction and cardiovascular disease.
Figure 2: Creatinine clearance in relation to age in a nondiabetic population in the PREVEND study.
Figure 3: Age-adjusted risks of death, cardiovascular events, and hospitalization in relation to estimated glomerular filtration rate in 1,120,295 participants enrolled in a major health maintenance organization in northern CA, USA.
Figure 4: Kaplan–Meier curves showing the effect of the angiotensin-converting-enzyme inhibitor captopril on survival free from heart failure after a first myocardial infarction.
Figure 5: Incidence of cardiovascular endpoints and heart failure according to the degree of inhibition of proteinuria achieved with angiotensin receptor blockers in the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) study.

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Acknowledgements

PAREXEL MMS provided writing assistance, comprising preparation of a draft from slides and audio transcript, preparation of figures and obtaining copyright permissions, proofreading, and reference checking.

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  1. Department of Clinical Pharmacology, University Medical Center Groningen, University of Groningen, Ant Deusinglaan 1, 9713 AV Groningen, The Netherlands d.de.zeeuw@med.umcg.nl

Authors and Affiliations

  1. D de Zeeuw is Professor and Chair of the Department of Clinical Pharmacology with a joint appointment in the Department of Nephrology, University Medical Center, Groningen, The Netherlands.,

    Dick de Zeeuw

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de Zeeuw, D. Renal disease: a common and a silent killer. Nat Rev Cardiol 5 (Suppl 1), S27–S35 (2008). https://doi.org/10.1038/ncpcardio0853

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