Kidney disease and cardiovascular risks

Cardiovascular disease (CVD) is the most common cause of death in people with chronic (ongoing) kidney disease. Compared to the general population, people with chronic kidney disease are up to 20 times more likely to have cardiovascular (heart and blood vessel) problems such as angina, heart attack, stroke or heart failure.

This increased risk is partly caused by factors common to both chronic kidney disease and CVD, such as high blood pressure. However, researchers are discovering that chronic kidney disease is, in itself, an important risk factor for the development of CVD.

Diabetes plays a major role
Diabetes is the main cause of kidney failure (also known as ‘end stage renal failure’ or ESRF). About 20 to 30 per cent of people with diabetes develop a type of kidney disease called diabetic nephropathy. A person with diabetic nephropathy is about 50 times more likely than the general population to develop CVD.

Shared risk factors
As well as diabetes, there are other risk factors that increase your risk of developing chronic kidney disease. These include:

• High blood pressure
• Being over 50
• A family history of chronic kidney disease
• Being of Aboriginal or Torres Strait Islander background
• Cigarette smoking
• Obesity.

• High blood pressure – the kidneys help to regulate blood pressure by producing a hormone called renin. They also help to regulate the amount of salt and fluid in the body.
• Heart strain – holding excess fluid in the body puts strain on the heart and increases the risk of complications such as left ventricular hypertrophy (enlarged left heart chamber), which can cause heart failure.
• Stiff arteries – kidneys make a hormone that helps to regulate the use of calcium throughout the body. A person with chronic kidney disease may develop calcified (stiffened) arteries and heart valves, perhaps caused by hormones not being produced efficiently.
• Increased blood fats (hyperlipidaemia) – some people with chronic kidney disease have increased levels of low-density lipoprotein (LDL) cholesterol, which may be caused by disturbed hormone levels. High LDL cholesterol is a known risk factor in the development of CVD.
• Blood clots – the blood of a person with chronic kidney disease is prone to clotting. A clot (thrombus) lodged within a blood vessel may cut off the blood supply. This increases the risk of many complications including heart attack and stroke. A clot in one of the kidney arteries may cause high blood pressure.

• Electrocardiogram – a test that checks the electrical activity of the heart
• Echocardiogram – an ultrasound scan of the heart
• Magnetic resonance imaging (MRI) – a scan that makes images by combining a strong magnetic field with radio waves
• Coronary angiography – a special x-ray examination of the heart.

• Healthier lifestyle habits – such as eating a healthy diet, doing regular physical activity and being a non-smoker. Making changes to your lifestyle may help to manage risk factors such as high blood pressure and high blood cholesterol.
• Early treatment of chronic kidney disease – this can both reduce the risk of CVD and prevent further kidney damage.
• Medical treatment – management of high blood pressure and high cholesterol may include medications.
• Surgery – an operation, such as a coronary artery bypass graft, may be needed to treat or prevent cardiovascular complications. However, chronic kidney disease increases the risk of postoperative complications.

• Your doctor
• Kidney Health Australia Information Line Tel. 1800 4 KIDNEY (543 639), TTY 1800 005 881

• Cardiovascular disease (CVD) is a common complication of chronic kidney disease.
• While CVD and chronic kidney disease share many risk factors (such as unhealthy diet and lack of physical activity), chronic kidney disease is, in itself, an important risk factor in the development of CVD.
• Medical treatment that prevents further kidney damage can reduce the person’s risk of CVD.

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