Why is chronic kidney disease the "spoiler" for cardiovascular outcomes?

The modern-day, first-world epidemics of obesity and hypertension are central drivers of an epidemic of combined chronic kidney disease (CKD) and cardiovascular disease (CVD) (1). Among those with diabetes for 25 years or more, the prevalence of diabetic nephropathy in type 1 and type 2 diabetes is 57% and 48%, respectively (2). Approximately half of all cases of end-stage renal disease (ESRD) are due to diabetic nephropathy, with most of these cases driven by obesity-related type 2 diabetes and hypertension. With the graying of America, and cardiovascular care shifting towards the elderly, there is an imperative to understand why decreasing levels of renal dysfunction act as a major adverse prognostic factor after cardiovascular events.