Coronary artery disease in patients with chronic kidney disease – is prevention possible?

Coronary artery disease (CAD) and chronic kidney disease (CKD) may reciprocally influence each other and increased risk of many complications, especially ischemic and hemorrhagic events, which complicates the treatment and prognosis of these patients (pts). The pts with both diseases heart failure is present in 43% pts and acute myocardial (AMI) in 15% pts; the equivalent proportion in pts with CAD without kidney disease were 18.5% and 6.4% respectively (1). Not only the pts with CKD in advanced stage 4 or 5 are at high risk of CAD morbidity and mortality but, also the patients with early stage of CKD and without clinical manifestation of vascular disease (2,3). The co-existence of two diseases are strongly interrelated, and explanations could be in the same risk factors responsible for both diseases progression. The prevention of risk factors is key and possible for a better prognosis and treatment options for these pts. Traditional and mutual risk factors of CAD and CKD are age, hypertension, diabetes mellitus, dyslipidemia, tobacco use, obesity, family history and male gender. Some of these factors, as high blood pressure, glucose, lipid levels, tobacco use can and should be aggressively modified. A common and very important findings in progression of three risk factors for CKD – hypertension, diabetes and dyslipidemia, is microalbuminuria, which is an essential predictor of identifying those patients at risk of kidney disease risk progression. National Kidney Foundation underlies the importance of early identification and treatment of CKD and its associated comorbid conditions, including cardiovascular disease (4,5).