This document summarizes Raheli Peled's research on cardiovascular complications from chronic renal failure. It defines chronic kidney disease and finds that CKD patients are at much higher risk for cardiovascular disease even in early stages. CVD is the leading cause of death for CKD patients. The relationship between CKD and CVD is multifactorial, as each condition can contribute to the progression of the other through traditional and non-traditional risk factors. Early screening and treatment of modifiable risk factors like controlling blood pressure, lipids, and blood sugar are important for managing CVD risk in CKD patients. Arteriovenous fistulas used for hemodialysis can also impact cardiac function, so careful evaluation of cardiac patients is needed before use

1. Raheli Peled
Supervisor: MUDr. Alojz Rajnič, PhD.
Cardiovascular Complications
by Chronic Renal Failure
Medical faculty P.J Safarik university Kosice
4th Department of Internal Medicine
2018

2. Introduction
• Chronic kidney disease (CKD) is a public health
problem affecting app. 10% of the population
• Cardiovascular disease (CVD) is highly
prevalent among CKD patients
• CVD is the leading cause of morbidity and
mortality in CKD even in early stages of CKD
• Individuals with CKD are more likely to die of
CVD than to progress to ESRD

3. Research question
How does CKD contribute to the development of
CVD and what should be the implication on
screening, diagnosis, prevention, and
management of CVD in this patient population?

4. Definition of CKD
• KDIGO 2012: Clinical Practice Guideline for the Evaluation and Management of CKD
–CKD includes abnormalities of kidney
structure or function, present for >3
months, with implications for health
Criteria for CKD (either of the following present for >3 months)
Markers of kidney
damage >1
Albuminuria
Urine sediment abnormalities
Electrolyte and other abnormalities due to tubular
disorders
Abnormalities detected by histology
Structural abnormalities detected by imaging
History of kidney transplantation
Decreased GFR GFR <60 ml/min/1.73 m2 (GFR categories G3a–G5)

5. CKD as an independent CVD risk
factor
• Studies have demonstrated an independent
association between CKD and CVD risk
• CKD patients are at higher risk of cardiovascular
mortality and adverse outcomes
• CKD patients are in the highest risk group for
CVD even in early stages of kidney disease
• CVD risk becomes more profound when GFR
decreases below 60 ml/min/1.73m2

6. Prevalence of CVD in patients with
or without CKD
AFIB- atrial fibrillation
AMI- acute myocardial infarction
ASHD- atherosclerotic heart disease
CHF- congestive heart failure
SCA/ VA- sudden cardiac arrest and ventricular
arrhythmia
VHD- valvular heart disease
PAD- peripheral artery disease
VTE/ PE- venous thromboembolism and
pulmonary embolism
CKD- chronic kidney disease
CVD- cardiovascular disease
USRDS annual data report. 2016

7. CKD prevalence in CVD
Shlipak et al. JASN. 2004

8. CVD mortality general population
vs. ESRD patients
Foley RN et al. 1998

9. Mortality rate and cardiovascular
events rise as GFR declines

10. CKD and CVD relationship
• A cycle of progression- each
condition contributes to the
pathogenesis of the other
• CKD has been associated
with increased prevalence
of traditional and non-
traditional CVD risk factors
• Many CVD risk factors are
also risk factors for
progression of CKD
Menon et al. 2005

11. CVD in CKD- multifactorial
pathogenesis

12. Spectrum of CVD in CKD patients
• Primary types of CVD in CKD patients are:
arterial vascular disease, cardiomyopathies,
and valvular diseases
Menon et al. 2005

13. Clinical consequences
• Heart failure- “cardio-renal syndrome”
– A pathophysiological disorder of the heart and kidneys whereby acute or chronic
dysfunction of one organ may induce acute or chronic dysfunction of the other
• Coronary artery disease (CAD)
• Namely angina pectoris and myocardial infarction
• Arrhythmias
– Alterations in cardiovascular system structure and function, metabolic
homeostasis and autonomic nervous system
– Sudden cardiac death
• Studies showed an inverse
relationship between GFR and SCD
PH Pun et al. 2009

14. Diagnosis & Treatment of CVD risk
factors in CKD patients
• Screening
– All symptomatic patients should be tested with an ECG and echocardiogram.
According to availability- stress echocardiography. High risk- angiography
– Not recommended in asymptomatic low-risk patients who are over 50 years
• Risk factors modification
– Lifestyle changes, lipid level control, blood pressure control, smoking
cessation, weight reduction, active lifestyle, glycaemia control correction of
anemia, aspirin use
• Treatment of CVD
– Pharmacological/ surgical

15. Conclusion
• CVD is the leading cause of morbidity and
mortality in CKD patients
• CKD patients are in the highest risk group for
developing CVD even in early stages
• CKD patients often have several traditional &
nontraditional risk factors for CVD
• Early diagnosis and treatment of modifiable
cardiovascular risk factors

16. Role of AV fistulas in the
pathogenesis of cardiovascular
complications in CRF
• AV fistulas are considered the preferred choice
of vascular access for hemodialysis
• Recent studies suggest AV fistulas have
significant and potentially deleterious effects
on cardiac functions particularly in the setting
of preexisting heart disease

17. Continued…
• A study using CV MRI found that AV fistulas
formation in ESRD patients was associated
with a significant increase in cardiac output,
dilation of all cardiac chambers, changes in SV,
and deterioration in endothelial function

18. Continued…
• AV fistulas are well tolerated by most patients
• AV fistulas carry a potential risk, particularly in
patients with preexisting CVD
• Recommendation is a thorough evaluation of
cardiac patients before AV fistula
• Additionally, patients who develop dyspnea,
HF, or pulmonary hypertension, AVF revision
should be considered as an important
therapeutic option

19. Thank you for your attention!