Kidney Disease as a Risk Factor for Development of Cardiovascular Disease: A Statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention

There is a high prevalence of CVD in subjects with CKD. The presence of CKD, whether it is manifested by proteinuria (albuminuria) or reduced GFR, appears to be an independent risk factor for CVD outcomes, particularly in higher-risk populations. These findings are consistent with the NKF task force recommendation that patients with CKD should be considered in the highest-risk group for CVD events. The seventh report of the Joint National Committee for the Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC-7) includes CKD as a "compelling" indication, justifying lower target blood pressure and treatment with specific antihypertensive agents. Similarly, the recently published "NKF-K/DOQI Clinical Practice Guidelines on Managing Dyslipidemia in Chronic Kidney Disease" recommend that all patients with CKD be included in the highest-risk group, justifying a lower target low-density lipoprotein cholesterol level. By contrast, the third report of the Adult Treatment Panel of the National Cholesterol Education Program (ATP-III) does not include CKD in the list of high-risk conditions necessitating more aggressive management. We suggest that the National Cholesterol Education Program and other groups include CKD in the highest-risk group for recommendations for prevention, detection, and treatment of CVD risk factors. In addition, these findings reinforce the recent recommendation from the NKF on the importance of early identification and treatment of CKD and its associated comorbid conditions. We suggest that the routine evaluation of patients with CVD or those at high risk for CVD include measurement of spot urine albumin-to-creatinine ratio or total protein-to-creatinine ratio and estimation of GFR by serum creatinine and prediction equations. Finally, there is an urgent need for additional randomized controlled studies to evaluate potential treatments of CVD in CKD.