Links between chronic kidney disease and cardiovascular disease: A bidirectional relationship

Abstract

A strong relationship between chronic kidney disease (CKD) and accelerated cardiovascular disease, defined as the cardiorenal syndrome, is well documented, whether the initial event is in the kidney or in the heart. In the kidney context, mechanisms that link CKD and cardiovascular disease (CVD) involve both conventional and CKD (uremia)-related CVD risk factors. Several pathophysiologic processes responsible for the accelerated CVD spectrum in the CKD population include accelerated calcific occlusive atheromatous disease, diffuse nonocclusive medial-wall calcification, endothelial dysfunction, and uremic cardiomyopathy. In the heart context, disturbed CV dynamics and activation of neurohormonal and inflammatory factors are involved in the initiation of renal functional impairment and progressive kidney disease. The aim of this chapter is to present an overview of various aspects of cardiorenal association and to pinpoint features that are specific to each clinical entity, whether the initial insult is renal or cardiac. A detailed discussion of the various aspects of cardiorenal association are well covered in the following chapters. © 2010 Springer-Verlag Milan.