Accelerated atherosclerosis in patients with Chronic Kidney Disease - the role of traditional and non-traditional risk factors

It is becoming increasingly more evident that accelerated atherosclerosis is a serious problem in patients with chronic kidney disease (CKD), with more patients dying prematurely from cardiovascular related diseases than progressing to end stage renal disease. A literature review was conducted to investigate the role of both traditional and non-traditional risk factors of atherosclerosis in these patients, to determine which risk factors had more of a significant effect. Findings showed that underlying pathophysiological mechanisms of the non-traditional risk factors such as inflammation were more heavily involved in creating an environment for development of atherosclerosis in CKD patients. It is therefore vital that primary and secondary prevention strategies are implemented early on in CKD, which would inevitably lead to a better prognosis for such patients. Introduction to Chronic Kidney Disease Chronic Kidney disease (CKD) represents a progressive decline in renal function which can be caused by numerous conditions such as diabetic nephropathy, hypertension and vascular disease. ‘The Kidney Disease Outcomes Quality Initiative’ (KDOQI) defines CKD as a glomerular filtration rate (GFR) of less than, or equal to 60 ml/min/1.73 m2 of one’s body weight for at least 3 months, regardless of the underlying aetiology of the kidney damage. This specific GFR marks a 50% reduction rate in kidney function in comparison to healthy adults . Despite the rising prevalence of CKD, it is often left undetected until the disease has advanced considerably, due to its largely asymptomatic nature. This leads to an earlier onset of end stage renal disease (ESRD) in the patient because of lack of secondary preventative measures . For this reason, the NICE guidelines in relation to CKD management aim to actively detect CKD and, wherever possible, prevent progression to renal failure . Furthermore, CKD often presents with a multitude of extra-renal complicat ions. Amongst these complications are those that contribute to the acceleration of atherosclerosis and CVD, facilitated by the presence of traditional and non-traditional risk factors for CVD in CKD patients. Classification of CKD ‘The Kidney Disease Outcomes Quality Initiative’ (KDOQI) have classified the stages of CKD solely on glomerular filtration rate (GFR). However, it has been revised by ‘National service framework for renal services’ to include the clauses of persistent proteinuria, albuminuria, haematuria or structural abnormalities in stages 1 & 2 as well as the stated low GFR. Stage Description GFR (mL/min1.73m2) 1 Kidney damage with normal or increased GFR >or equal to 90 2 Kidney damage with mild decrease in GFR 60 – 89 3 Moderate decrease in GFR 30 – 59 4 Severe decrease in GFR 15 – 29 5 Kidney failure < 15 (or dialysis) Figure 1: Adapted from NKF-NDOQI CKD guidelines [2]