Cardiovascular Outcomes in Patients with Chronic Kidney Disease

Chronic kidney disease (CKD) substantially elevates the risk of adverse cardiovascular events, reflecting a complex interplay between declining renal function and cardiovascular pathophysiology. Even in its early stages, CKD is associated with accelerated atherosclerosis, endothelial dysfunction and vascular calcification, contributing to higher rates of myocardial infarction, heart failure and sudden cardiac death. Reduced glomerular filtration rate and proteinuria serve both as markers and mediators of cardiovascular injury, while systemic inflammation, oxidative stress and disturbances in mineral metabolism further exacerbate vascular damage. In patients with established cardiovascular disease, the presence of CKD or progression to end-stage renal disease (ESRD) markedly worsens mid-term and long-term outcomes, including increased mortality, recurrent hospitalisation and treatment complications. The management of this population requires a multifaceted approach: optimisation of blood pressure and glycaemic control, judicious use of renoprotective and cardioprotective agents, and tailored revascularisation strategies. Emerging tools for risk stratification, such as machine learning models, promise more accurate prediction of in-hospital and post-discharge outcomes, enabling personalised therapeutic pathways. Globally, CKD affects hundreds of millions of individuals, and its intersection with cardiovascular disease represents a major public health challenge demanding integrated clinical and research efforts.

Research from Nature Portfolio

Recent studies have quantified the impact of CKD and ESRD on mid-term outcomes in patients with established cardiovascular disease and diabetes. In a large observational cohort, individuals with CKD exhibited a substantially higher one-year all-cause mortality and recurrent atherosclerotic cardiovascular disease or heart-failure hospitalisations compared with those without renal impairment. Those with ESRD experienced even greater hazards for cardiovascular death and rehospitalisation. Analyses controlling for age, sex and medication use highlighted the independent contribution of declining renal function to adverse events, underscoring the need for vigilant monitoring and early intervention in patients who develop renal dysfunction on the background of cardiovascular disease.

Cardiovascular Outcomes in Patients with Chronic Kidney Disease publication trend

The graph below shows the total number of articles in cardiovascular outcomes in patients with chronic kidney disease across all publications each year (not limited to Nature Index journals).

Technical terms

Chronic kidney disease (CKD): A gradual loss of kidney function over time, typically classified by reduced glomerular filtration rate or evidence of kidney damage such as proteinuria.

Estimated glomerular filtration rate (eGFR): A calculated measure of kidney function based on serum creatinine, age, sex and body size, used to stage CKD.

End-stage renal disease (ESRD): The most advanced stage of CKD, in which kidney function is inadequate to sustain life without dialysis or transplantation.

Atherosclerotic cardiovascular disease (ASCVD): A spectrum of conditions—including coronary artery disease and peripheral arterial disease—resulting from the build-up of plaque in arterial walls.

References

1. Impact of chronic kidney disease and end-stage renal disease on the mid-term adverse outcomes in diabetic patients with cardiovascular diseases. Scientific Reports (2024).
2. A Cross-Sectional Study on the Prevalence and Risk Stratification of Chronic Kidney Disease in Cardiological Patients in São Paulo, Brazil. Diagnostics (2023).
3. The prediction of in-hospital mortality in chronic kidney disease patients with coronary artery disease using machine learning models. European Journal of Medical Research (2023).