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Patients with chronic kidney disease (CKD) are at higher risk for premature cardiovascular disease and events in comparison with the general population. This appears to result from a complex interplay of various metabolic and vascular factors. There are some underlying differences in the lipid profile of CKD patients versus individuals without CKD. Among them are an abundance of small, dense, atherogenic LDL particles; elevated concentrations of triglycerides; reduced HDL cholesterol concentrations; altered lipoproteins; and the presence of lipoprotein and chylomicron remnants—findings that are characteristic of the lipid profile in this population. Among other variables that affect the heightened propensity of
P eople with kidney disease are medically complex, and kidney disease may have an impact on the development of therapies to treat the many comorbidities affecting this population. Cardiovascular disease is a common and significant comorbidity among these patients, and individuals with kidney disease make up a sizeable proportion (30% to 60%) of patients with cardiovascular disease (
The Kidney Health Initiative (KHI)
Dyslipidemia has long been established as a traditional risk factor for cardiovascular disease in the general population. Dyslipidemia, characterized especially by elevated LDL and VLDL, is well known to be associated with higher atherosclerotic cardiovascular disease risk and is a large public health threat.
In patients with chronic kidney disease (CKD) and end stage renal disease (ESRD), cardiovascular disease is accelerated with an even larger impact, compared with the general population. Multiple variables are thought to contribute to this heightened propensity to and accelerated course of cardiovascular disease, including significant alterations in lipoprotein metabolism such as decreased HDL and increased
Until recently, transcatheter aortic valve replacement (TAVR) has been a treatment option for patients with severe symptomatic aortic stenosis who are not candidates for surgical aortic valve replacement (SAVR). It has been used for patients who are at high or intermediate surgical risk, but recent studies have demonstrated the noninferiority and also superiority of TAVR compared with SAVR in patients at low surgical risk (
Transcatheter mitral valve repair (TMVR) is a minimally invasive procedure used as a treatment option for patients with symptomatic chronic moderate to severe, or severe mitral regurgitation (MR). The MitraClip is an edge-to-edge leaflet repair device and is currently the only device approved by the U.S. Food and Drug Administration for TMVR. MR is one of the most common valve lesions. Patients with chronic kidney disease (CKD) and MR usually have multiple comorbidities, increasing their surgical risk for valve replacement and making them possible candidates for TMVR by use of the MitraClip. The interaction between MR and the kidney is
KDIGO’s history is a history of guidelines in nephrology. There were none in 1994 when a conference called Controversies in the Quality of Dialysis Care was held under the auspices of the National Kidney Foundation (NKF, United States). It was co-chaired by Dr. Gary Eknoyan. One recommendation from that event was the call for the development of nephrology guidelines. That thought resonated with various stakeholders, who provided funding and expertise to enable the NKF to develop evidence-based clinical practice guidelines. Four guidelines under the banner of the DOQI (Dialysis Outcomes Quality Initiative) were published in 1997.
Those guidelines made a
The complex interplay between the kidney and the heart where one organ dysfunction can initiate or accelerate the decline of the other was recently addressed at a KDIGO Controversies Conference on the prevention, diagnosis, and management of heart failure in kidney disease (
My involvement with KDIGO began a decade ago. In December 2009, international co-chairs Bertram Kasiske, MD, and Prof. Dr. Kai-Uwe Eckardt invited me to co-chair a Controversies Conference on cardiovascular disease in chronic kidney disease (CKD) with Professor Eberhard Ritz.
This conference, titled “Cardiovascular disease in CKD: What is it and what can we do about it?” was held in October 2010 in London. It focused on areas of clinical relevance in four breakout groups: 1) coronary artery disease and myocardial infarction; 2) congestive heart failure; 3) cerebrovascular disease, stroke, atrial fibrillation, and peripheral arterial disease; and 4) sudden cardiac
The Kidney Disease: Improving Global Outcomes (KDIGO) 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) represented a selective update of the prior CKD-MBD guideline published in 2009 (
The 2017 guideline update focused on recommendations for the diagnosis of bone abnormalities in CKD-MBD; treatment of CKD-MBD by lowering serum phosphate
Diabetes treatment has advanced rapidly over the past decade, with new drugs and technologies developed and translated into clinical care. Many of these treatments affect the kidney, are affected by chronic kidney disease (CKD), or carry both effects. In addition, new data have been published on foundational elements of care for people with diabetes and CKD, including lifestyle, ascertainment of glycemia, glycemic targets, and use of renin-angiotensin system (RAS) inhibitors. Providers and patients rightly ask how to apply the new treatments and integrate them into tailored existing care paradigms.
KDIGO has initiated a new clinical practice guideline to help guide
