40. Cardiovascular Complications in Patients with Renal Disease

Chronic kidney disease includes both patients with a low glomerular filtration rate (GFR) and those with a normal GFR and abnormal albumin excretion in their urine. The former make up approximately 4 % of the adult population and the latter an additional 3–4 %. Both a low GFR and the presence of abnormal amount of albumin in the urine indicate that the patient is at higher risk not only of progressive kidney disease but that they are also at much greater risk of cardiovascular disease. Fortunately the condition can be identified through screening of renal function, urine albumin, and blood pressure measurement. Therapy to reduce global cardiovascular risk should include control of blood pressure, treatment with the maximal recommended dose of an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker, aggressive LDL lowering, management of diabetes, as well as lifestyle changes including diet, exercise, and smoking cessation. Together these therapies represent “optimal medical therapy” and are particularly effective when managed by an interprofessional and interdisciplinary team. For the practicing clinician, the finding of a low GFR or abnormal albuminuria should constitute an “action item” for pursuing the evaluation and diagnosis of potentially unsuspected cardiac involvement and the initiation of multimodal therapy to lower cardiovascular and renal risk.