Early Kidney Disease Significantly Elevates Cardiovascular Risk, New Review Finds
A large systematic review underscores that cardiovascular complications increasingly define outcomes for individuals with chronic kidney disease (CKD), even in the early stages of impairment, demanding a shift in preventative care.
Cardiovascular disease remains the leading cause of death among those with CKD, and a comprehensive analysis of existing research reveals the risk emerges and intensifies far earlier than previously understood. Published in Medicine in January 2025, the review synthesized data from seven observational and cohort studies, highlighting a critical need for improved risk identification and tailored management strategies.
The Growing Burden of CKD and Cardiovascular Disease
Chronic kidney disease affects an estimated 10% of the global population and is now recognized as a major, often underestimated, risk factor for cardiovascular disease (CVD). While advanced CKD is widely acknowledged to increase cardiovascular risk, uncertainty has lingered regarding the timing of this risk and the extent to which it’s driven by kidney-specific factors versus traditional risk factors.
Investigators found that across diverse populations and varying stages of CKD, individuals with kidney disease consistently experienced higher rates of coronary heart disease, stroke, and cardiovascular death compared to those with normal kidney function. This finding reinforces the urgency of addressing cardiovascular health in CKD patients.
Risk Escalates Even with Mild Kidney Impairment
The review’s most striking finding is the demonstrable increase in cardiovascular risk even in the early stages of kidney disease. “Addressing cardiovascular risk in CKD patients is crucial to reducing mortality and improving their overall quality of life,” one author noted. Specifically, a large population-based cohort revealed that mild reductions in estimated glomerular filtration rate (eGFR) were associated with roughly a 50% higher risk of coronary heart disease and cardiovascular mortality. Another community-based study indicated that individuals with CKD had a fourfold higher estimated 10-year cardiovascular risk than those without the condition.
Beyond Traditional Risk Factors: The Role of CKD-Specific Mechanisms
While traditional cardiovascular risk factors – including hypertension, diabetes, obesity, and dyslipidemia – are highly prevalent among those with CKD and tend to worsen as kidney function declines, the review emphasizes that these factors don’t tell the whole story. Nontraditional CKD-specific mechanisms – such as chronic inflammation, oxidative stress, uremic toxins, mineral metabolism disturbances, and anemia – likely amplify cardiovascular risk beyond what standard models predict.
One prospective study highlighted the significance of coronary microvascular dysfunction, demonstrating that individuals with CKD and impaired coronary flow reserve had more than twice the risk of cardiac death compared to those with preserved flow. .
Implications for Clinical Practice and Future Research
The authors emphasize that standard cardiovascular interventions often prove less effective in individuals with CKD due to the unique pathophysiology of the disease and the presence of competing risks. While foundational treatments like antihypertensive agents, statins, and glucose-lowering therapies remain important, achieving treatment targets can be challenging, particularly in advanced CKD.
Emerging therapies, including sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists, show promise for improving both cardiovascular and renal outcomes, but further research is needed to establish their long-term efficacy and safety in CKD populations.
The review underscores the need for earlier identification of cardiovascular risk in CKD, improved risk stratification tools, and more individualized, multimodal management approaches. Furthermore, the authors call for greater inclusion of patients with reduced kidney function in cardiovascular trials to ensure that guideline-based interventions are applicable to this vulnerable population.
Despite limitations – including the observational nature of most included studies and heterogeneity in study designs – the review provides compelling evidence that cardiovascular risk in CKD begins early and escalates alongside declining kidney function. The findings reinforce the critical need for a proactive and comprehensive approach to cardiovascular care in individuals with chronic kidney disease.
