Cardiovascular Disease and the Kidney

Cardiovascular Disease and the Kidney

People 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 (1, 2).

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.

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.

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 (1), and TAVR has found a role in patients with kidney disease as well. The number of TAVR procedures is therefore expected to grow.

It has been well known for many years that cardiovascular disease disproportionately affects patients with chronic kidney disease (CKD) and kidney failure, both through acceleration of atherogenesis as a consequence of reduced kidney function and through the various comorbidities with which our patients are frequently afflicted.