Chronic kidney disease and the cardiovascular connection

Abstract

The heart and the kidneys are linked and work in concert to manage blood pressure, salt, and water balance, neurohormonal systems, and cell signaling systems. The presence of chronic kidney disease has consistently predicted the development and worsening of cardiovascular disease in human studies. The most prominent feature of atherosclerosis in patients with kidney disease is accelerated calcification as a manifestation of mineral and bone disorder. The development of effort intolerance, dyspnea, and peripheral edema commonly heralds the presence of heart failure but can also be attributed to some forms of chronic kidney disease, particularly nephrotic syndrome. Hospitalization for heart failure is the most frequent manifestation of cardiovascular disease in patients with kidney disease. The most common forms of valvular disease are aortic valve calcification resulting in sclerosis and/or stenosis and/or mitral annular calcification. Because of myocardial disease, electrolyte imbalance, and acid-base disturbances, all forms of arrhythmias are more frequent in patients with kidney disease, particularly those patients receiving dialysis therapy. In summary, there is a very strong link between heart and kidney disease, and hence, they can be viewed as a “cardiorenal” system at risk for disease in both organs.