Cardiovascular Risk Factors in Chronic Kidney Disease

Chronic kidney disease (CKD) affects millions worldwide and markedly elevates the risk of cardiovascular morbidity and mortality. In addition to conventional factors such as hypertension, dyslipidaemia and diabetes, CKD introduces a spectrum of non-traditional contributors that amplify cardiovascular risk. Reduced glomerular filtration rate and persistent albuminuria both predict adverse cardiac and cerebrovascular outcomes. At a molecular level, uraemic toxins, chronic low-grade inflammation and oxidative stress impair endothelial function and promote vascular calcification. Disordered mineral metabolism—characterised by hyperphosphataemia, elevated fibroblast growth factor 23 and deficiency of active vitamin D—drives arterial stiffness and left ventricular hypertrophy. Volume overload, sympathetic overactivity and anaemia further burden the heart, creating a milieu conducive to heart failure, arrhythmias and sudden cardiac death. The interplay between these factors necessitates integrated risk stratification and targeted interventions to attenuate cardiovascular events in CKD populations.

Research from Nature Portfolio

Recent interventional work has explored modulation of inflammation to reduce cardiovascular risk in dialysis patients. A phase 2b trial investigated an anti-interleukin 6 antibody administered every four weeks in individuals receiving maintenance dialysis with elevated C-reactive protein. Treatment led to substantial reductions in systemic inflammatory biomarkers, including high-sensitivity C-reactive protein and fibrinogen, alongside favourable shifts in lipoprotein(a) and serum albumin. The safety profile was acceptable at lower doses, suggesting that targeted cytokine inhibition may represent a novel strategy to mitigate cardiovascular risk in advanced CKD.

Cardiovascular Risk Factors in Chronic Kidney Disease publication trend

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

Technical terms

eGFR: Estimated glomerular filtration rate, a calculated index of kidney filtration function.

Albuminuria: Presence of albumin in urine, indicating glomerular damage and cardiovascular risk.

Endothelial dysfunction: Impaired vascular lining response, leading to vasoconstriction and thrombosis.

Fibroblast growth factor 23 (FGF23): Hormone regulating phosphate excretion, elevated in CKD and linked to cardiac hypertrophy.

Uraemic toxins: Accumulated waste metabolites that promote inflammation, oxidative stress and vascular injury.

Sodium–glucose cotransporter 2 inhibitors: Glucose-lowering drugs that confer cardiovascular and renal protection.

Hypoxia-inducible factor prolyl hydroxylase inhibitors: Oral agents that stimulate erythropoiesis, addressing anaemia in CKD.

References

1. IL-6 inhibition with clazakizumab in patients receiving maintenance dialysis: a randomized phase 2b trial. Nature Medicine (2024).
2. Cardiovascular complications in chronic kidney disease: a review from the European Renal and Cardiovascular Medicine Working Group of the European Renal Association. Cardiovascular Research (2023).
3. Cardiovascular disease risk factors in chronic kidney disease: A systematic review and meta-analysis. PLOS ONE (2018).
4. Endothelial Dysfunction in Chronic Kidney Disease, from Biology to Clinical Outcomes: A 2020 Update. Journal of Clinical Medicine (2020).