Global cardiovascular protection in chronic kidney disease

Nat Rev Cardiol. 2016 Oct;13(10):603-8. doi: 10.1038/nrcardio.2016.48. Epub 2016 Apr 7.

Abstract

The development and progression of cardiovascular disease (CVD) and renal disorders are very closely related. In patients with chronic kidney disease (CKD), therapies proven to protect the cardiovascular and renal systems simultaneously are generally used only at low doses or not at all. In particular, patients with CKD who receive angiotensin-converting-enzyme inhibitors, angiotensin-receptor blockers, or mineralocorticoid-receptor antagonists (MRAs) often do not experience complete blockade of the renin-angiotensin-aldosterone system, primarily owing to the risk of hyperkalaemia. In this Review, we provide an overview of the available treatments required for adequate cardiorenal protection in patients with CKD. Drugs such as β-blockers that interfere with renin secretion will be discussed, in addition to agents that can prevent hyperkalaemia, such as potassium binders and nonsteroidal MRAs. Furthermore, the current literature on the role of statins, in addition to new compounds and dosing recommendations for the treatment of patients with CKD will also be reviewed. Further studies with these new compounds and doses are needed to ascertain whether these approaches can improve the long-term cardiovascular and renal prognosis in patients with CKD.

Publication types

  • Review

MeSH terms

  • Cardio-Renal Syndrome / diagnosis
  • Cardio-Renal Syndrome / drug therapy*
  • Cardio-Renal Syndrome / mortality
  • Cardio-Renal Syndrome / physiopathology
  • Cardiovascular Agents / adverse effects
  • Cardiovascular Agents / therapeutic use*
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / drug therapy*
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / physiopathology
  • Humans
  • Renal Agents / adverse effects
  • Renal Agents / therapeutic use*
  • Renal Insufficiency, Chronic / diagnosis
  • Renal Insufficiency, Chronic / drug therapy*
  • Renal Insufficiency, Chronic / mortality
  • Renal Insufficiency, Chronic / physiopathology
  • Renin-Angiotensin System / drug effects*
  • Risk Factors
  • Treatment Outcome

Substances

  • Cardiovascular Agents
  • Renal Agents