Cardiorenal protection in advanced chronic kidney disease: research highlights from landmark papers published in Nephrology Dialysis Transplantation during 2018

Abstract

Chronic kidney disease (CKD) and cardiovascular disease go hand-in-hand and an inverse, strong and independent relationship exists between estimated glomerular filtration rate (eGFR) and the risk of cardiovascular morbidity and mortality [1, 2]. In fact, the mortality hazard attributable to CKD is even higher than the mortality risk arising from diabetes mellitus (DM) and comparable with that of established coronary artery disease, thus CKD is considered a coronary disease equivalent [3]. The burden of cardiovascular disease, particularly due to heart failure or the development of cardiac arrhythmias, is multiplied in those with end-stage renal disease (ESRD) on chronic dialysis. It has to be noted, however, that clinical trial evidence to guide the management of cardiovascular disease in these high-risk patients is scant [4]. This lack of evidence is at least partly attributable to the fact that advanced CKD/ESRD was systematically an exclusion criterion in the majority of large outcome trials that have demonstrated the safety and efficacy of several cardioprotective therapies in earlier stages of CKD or in the general population [4]. In this editorial we discuss therapeutic strategies to optimize cardiovascular and/or renal protection in advanced CKD based on research highlights from ‘landmark’ papers published in Nephrology Dialysis Transplantation during 2018. We provide ‘take-home messages’ from these studies and directions for future research in these important areas.