Skip to main content

Advertisement

SpringerLink
Log in

Cardiorenal Disease: A Clinical Intersection

  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

This review focuses on the association between renal insufficiency and cardiovascular disease and discusses therapeutic options. Although the association of chronic renal insufficiency and cardiovascular risk was first shown in patients with end-stage renal disease, even minor renal dysfunction has now been established as an independent risk for atherosclerotic cardiovascular disease. Treatment with angiotensin-converting enzyme inhibitors and statins can reduce cardiovascular morbidity and mortality in patients with renal insufficiency. Coronary revascularization improves the prognosis in patients with renal dysfunction, but there is still an underutilization of coronary revascularization procedures in patients with renal insufficiency. There is enough data that shows high mortality after percutaneous transluminal coronary angioplasty in patients with reduced renal function and that slight renal dysfunction exposes the patient with a cardiac event to an excessive cardiac mortality. Further investigation should focus on the cause of and possible preventive interventions, for the staggering cardiovascular risk in the ever-increasing number of people with renal dysfunction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. CE Lewis DR Jacobs SuffixJr H McCreath et al. (2000) ArticleTitleWeight gain continues in the 1990s: 10-year trends in weight and overweight from the CARDIA study Coronary Artery Risk Development in Young Adults Am J Epidemiol 151 IssueID12 1172–1181 Occurrence Handle10905529

    PubMed  Google Scholar 

  2. CM Mangano LS Diamondstone JG Ramsay et al. (1998) ArticleTitleRenal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. The Multicenter Study of Perioperative Ischemia Research Group Ann Intern Med 128 IssueID3 194–203 Occurrence Handle9454527

    PubMed  Google Scholar 

  3. HL Hillege AR Girbes PJ Kam Particlede et al. (2000) ArticleTitleRenal function, neurohormonal activation, and survival in patients with chronic heart failure Circulation 102 IssueID2 203–210 Occurrence Handle10889132

    PubMed  Google Scholar 

  4. US Renal Data System: USRDS 1999 Annual Data Report, Bethesda, MD, The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney diseases, 1999.

  5. DL Dries DV Exner MJ Domanski et al. (2000) ArticleTitleThe prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction J Am Coll Cardiol 35 IssueID3 681–689 Occurrence Handle10.1016/S0735-1097(99)00608-7 Occurrence Handle10716471

    Article  PubMed  Google Scholar 

  6. DS Silverberg D Wexler M Blum et al. (2003) ArticleTitleThe effect of correction of anaemia in diabetics and non-diabetics with severe resistant congestive heart failure and chronic renal failure by subcutaneous erythropoietin and intravenous iron Nephrol Dial Transplant 18 IssueID1 141–146 Occurrence Handle10.1093/ndt/18.1.141 Occurrence Handle12480972

    Article  PubMed  Google Scholar 

  7. D Duprez M Buyzere ParticleDe ER Rietzschel et al. (2000) ArticleTitleAldosterone and vascular damage Curr Hypertens Rep 2 IssueID3 327–334 Occurrence Handle10981167

    PubMed  Google Scholar 

  8. R Rocha PN Chander A Zuckerman et al. (1999) ArticleTitleRole of aldosterone in renal vascular injury in stroke-prone hypertensive rats Hypertension 33 IssueID1Pt2 232–237 Occurrence Handle9931110

    PubMed  Google Scholar 

  9. M. Epstein (2001) ArticleTitleAldosterone as a mediator of progressive renal dysfunction: evolving perspectives Intern Med 40 IssueID7 573–83 Occurrence Handle11506295

    PubMed  Google Scholar 

  10. B Pitt F Zannad WJ Remme et al. (1999) ArticleTitleThe effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators N Engl J Med 33 232–237

    Google Scholar 

  11. RN Foley BF Culleton PS Parfrey et al. (1997) ArticleTitleCardiac disease in diabetic end-stage renal disease Diabetologia 40 1307–1312 Occurrence Handle10.1007/s001250050825 Occurrence Handle9389423

    Article  PubMed  Google Scholar 

  12. JN Beattie SS Soman KR Sandberg et al. (2001) ArticleTitleDeterminants of mortality after myocardial infarction in patients with advanced renal dysfunction Am J Kidney Dis 37 1191–1200 Occurrence Handle11382688

    PubMed  Google Scholar 

  13. EL Hannan MJ Racz DT Arani et al. (2000) ArticleTitleShort and long term mortality for patients undergoing primary angioplasty for acute myocardial infarction J Am Coll Cardiol 36 1194–1201 Occurrence Handle10.1016/S0735-1097(00)00866-4 Occurrence Handle11028470

    Article  PubMed  Google Scholar 

  14. H Miettinen SM Haffner S Lehto et al. (1996) ArticleTitleProteinuria predicts stroke and other atherosclerotic vascular disease events in non-diabetic and non-insulin dependent diabetic subjects Stroke 27 2033–2039 Occurrence Handle8898811

    PubMed  Google Scholar 

  15. A Schmitz M. Vaeth (1988) ArticleTitleMicroalbuminuria: a major risk factor in non-insulin-dependent diabetes. A 10-year follow-up study of 503 patients Diabet Med 5 126–134 Occurrence Handle2964977

    PubMed  Google Scholar 

  16. Valmadrid CT, Klein R, Moss SE et al. (2000). The risk of cardiovascular disease mortality associated with microalbuminuria and gross proteinuria in persons with older-onset diabetes mellitus. Arch Intern Med 160: 1093–1100

    Google Scholar 

  17. JR Sowers M Epstein Frohlich (2001) ArticleTitleDiabetes, hypertension, and cardiovascular disease: an update Hypertension 37 1053–1059 Occurrence Handle11304502

    PubMed  Google Scholar 

  18. LL Humphrey DJ Ballard PP Frohnert et al. (1989) ArticleTitleChronic renal failure in non-insulin-dependent diabetes mellitus. A population based study in Rochester, Minnesota Ann Intern Med 111 788–796 Occurrence Handle2817626

    PubMed  Google Scholar 

  19. HC Gerstein JF Mann Q Yi et al. (2001) ArticleTitleHOPE Study Investigators. Albuminuria and risk of cardiovascular events, death and heart failure in diabetic and non-diabetic individuals JAMA 286 421–426 Occurrence Handle10.1001/jama.286.4.421 Occurrence Handle11466120

    Article  PubMed  Google Scholar 

  20. American Diabetes Association. Diabetic Nephropathy. Diabetes care 2002; 25(Suppl.): S85–S89.

    Google Scholar 

  21. R Turner R Holman I Stratton et al. (1998) ArticleTitleThe United Kingdom Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38 BMJ 317 703–713 Occurrence Handle9732337

    PubMed  Google Scholar 

  22. L Hansson A Zanchetti SG Carruthers et al. (1998) ArticleTitleEffects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension. Principal results of the hypertension optimal treatment (HOT) randomized trial. HOT Study Group Lancet 351 1755–1762 Occurrence Handle10.1016/S0140-6736(98)04311-6 Occurrence Handle9635947

    Article  PubMed  Google Scholar 

  23. AV Chobanian GL Bakris HR Black et al. (2003) ArticleTitleThe Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure JAMA 289 IssueID19 2560–2572 Occurrence Handle12748199

    PubMed  Google Scholar 

  24. MS Wu CC Yu CW Yang et al. (1997) ArticleTitlePoor pre-dialysis glycaemic control is a predictor of mortality in type II diabetic patients on maintenance haemodialysis Nephrol Dial Transplant 12 2105–2110 Occurrence Handle10.1093/ndt/12.10.2105 Occurrence Handle9351073

    Article  PubMed  Google Scholar 

  25. P Zager J Nikolic R Brown et al. (2002) ArticleTitleTight glycemic control improves survival in diabetic hemodialysis patients J Am Soc Nephrol 11 124A

    Google Scholar 

  26. Effect of intensive diabetes management on macrovascular events and risk factors in the Diabetes Control and Complications Trial. Am J Cardiol 1995; 75: 894–903.

  27. T Morioka M Emoto T Tabata et al. (2001) ArticleTitleGlycemic control is a predictor of survival for diabetic patients on hemodialysis Diabetes Care 24 909–913 Occurrence Handle11347753

    PubMed  Google Scholar 

  28. K Malmberg A Norhammer H Wedel et al. (1999) ArticleTitleGlycometabolic state at admission: important risk marker of mortality in conventionally treated patients with diabetes mellitus and acute myocardial infarction: long-term results from the Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study Circulation 99 2626–2632 Occurrence Handle10338454

    PubMed  Google Scholar 

  29. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). J Am Med Assoc 2001; 285: 2486–2497.

    Google Scholar 

  30. MRC/BHF heart protection study of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomized placebo-controlled trial. Lancet 2002; 360: 7–22.

    Google Scholar 

  31. Tonelli M, Moye L, Sacks F et al. Pravastatin is effective for secondary prevention of cardiovascular events in patients with chronic renal insufficiency (abstract). J Am Soc Nephrol 2001; 252A.

  32. National Kidney Foundation. K/DOQI clinical practice guidelines for managing dyslipidemias in chronic kidney disese. Am J Kidney Dis 2003; 41: S1–S92.

    Google Scholar 

  33. SM. Haffner (2004) ArticleTitleManagement of dyslipidemia in adults with diabetes Diabetes Care. 27 IssueIDSuppl. 1 S68–S71 Occurrence Handle14693930

    PubMed  Google Scholar 

  34. C Wanner V Krane G Ruf et al. (1999) ArticleTitleRationale and design of a trial improving outcome of type 2 diabetics on hemodialysis. Die Deutsche Diabetes Dialyse Studie Investigators Kidney Int 56 S222–S226 Occurrence Handle10.1046/j.1523-1755.1999.07158.x

    Article  Google Scholar 

  35. Y Song C Li L. Cai (2004) ArticleTitleFluvastatin prevents nephropathy likely through suppression of connective tissue growth factor-mediated extracellular matrix accumulation Exp Mol Pathol 76 IssueID1 66–75 Occurrence Handle10.1016/j.yexmp.2003.08.002 Occurrence Handle14738871

    Article  PubMed  Google Scholar 

  36. K Kano K Nishikura Y Yamada et al. (2003) ArticleTitleEffect of fluvastatin and dipyridamole on proteinuria and renal function in childhood IgA nephropathy with mild histological findings and moderate proteinuria Clin Nephrol 60 IssueID2 85–89 Occurrence Handle12940609

    PubMed  Google Scholar 

  37. NM Maisch KK. Pezzillo (2004) ArticleTitleHMG-CoA reductase inhibitors for the prevention of nephropathy Ann Pharmacother. 38 IssueID2 342–345 Occurrence Handle14742776

    PubMed  Google Scholar 

  38. RN Foley PS Parfrey JD Harnett et al. (1996) ArticleTitleThe impact of anemia on cardiomyopathy, morbidity and mortality in end-stage renal disease Am J Kidney Dis 28 53–61 Occurrence Handle8712222

    PubMed  Google Scholar 

  39. F Madore EG Lowrie C Brugnara et al. (1997) ArticleTitleAnemia in hemodialysis patients: variables affecting this outcome predictor J Am Soc Nephrol 8 1921–1929 Occurrence Handle9402095

    PubMed  Google Scholar 

  40. LG Fine D Bandyopadhay JT. Norman (2000) ArticleTitleIs there a common mechanism for the progression of different types of renal diseases other than proteinuria? Towards the unifying theme of chronic hypoxia Kidney Int Suppl. 75 S22–S6 Occurrence Handle10.1046/j.1523-1755.2000.07512.x Occurrence Handle10828757

    Article  PubMed  Google Scholar 

  41. PO Iversen PR Woldbaek T Tonnessen et al. (2002) ArticleTitleDecreased hematopoiesis in bone marrow of mice with congestive heart failure Am J Physiol Regul Integr Comp Physiol 282 IssueID1 R166–R72 Occurrence Handle11742835

    PubMed  Google Scholar 

  42. EH Herrera-Garza SJ Stetson A Cubillos–Garzon et al. (1999) ArticleTitleTumor necrosis factor-alpha: a mediator of disease progression in the failing human heart Chest 115 IssueID4 1170–1174 Occurrence Handle10.1378/chest.115.4.1170 Occurrence Handle10208224

    Article  PubMed  Google Scholar 

  43. RT Means SuffixJr. (1999) ArticleTitleAdvances in the anemia of chronic disease Int J Hematol 70 IssueID1 7–12 Occurrence Handle10446488

    PubMed  Google Scholar 

  44. W Siems F Carluccio T Grune et al. (2002) ArticleTitleElevated serum concentration of cardiotoxic lipid peroxidation products in chronic renal failure in relation to severity of anemia Clin Nephrol 58 IssueIDsuppl 1 S200–S5

    Google Scholar 

  45. LP McMahon MJ McKenna T Sangkabutra et al. (1999) ArticleTitlePhysical performance and associated electrolyte changes after haemoglobin normalization: a comparative study in haemodialysis patients Nephrol Dial Transplant 14 1182–1187 Occurrence Handle10.1093/ndt/14.5.1182 Occurrence Handle10344359

    Article  PubMed  Google Scholar 

  46. LP McMahon K Mason SL Skinner et al. (2000) ArticleTitleEffects of haemoglobin normalization on quality of life and cardiovascular parameters in end-stage renal failure Nephrol Dial Transplant 15 1425–1430 Occurrence Handle10.1093/ndt/15.9.1425 Occurrence Handle10978402

    Article  PubMed  Google Scholar 

  47. EJ Lewis LG Hunsicker WR Clarke et al. (2001) ArticleTitleCollaborative Study Group: renoprotective effect of the angiotension-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes N Engl J Med 234 851–860 Occurrence Handle10.1056/NEJMoa011303

    Article  Google Scholar 

  48. BM Brenner ME Cooper D Zeeuw Particlede et al. (2001) ArticleTitleRENAAL Study Investigators. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy N Engl J Med 345 861–869 Occurrence Handle11565518

    PubMed  Google Scholar 

  49. G Maschio D Alberti G Janin et al. (1996) ArticleTitleEffect of the angiotenin-converting-enzyme inhibitor benazepril on the progression of chronic renal insufficiency. The Angiotensin-Converting Enzyme Inhibition in Progressive Renal Insufficiency Study Group N. Engl J Med 334 939–945 Occurrence Handle10.1056/NEJM199604113341502 Occurrence Handle8596594

    Article  PubMed  Google Scholar 

  50. The GISEN group (Gruppo Italiano de Studi Epidemiologici in Nefrologia): randomised place-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. Lancet 1997; 349: 1857–1863.

    Google Scholar 

  51. P Ruggenenti A Perna G Gherardi et al. (1999) ArticleTitleRenoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria Lancet 354 359–364 Occurrence Handle10.1016/S0140-6736(98)10363-X Occurrence Handle10437863

    Article  PubMed  Google Scholar 

  52. LY Agodoa L Appel GL Bakris et al. (2001) ArticleTitleAfrican American Study of Kidney Disease and Hypertension (AASK) Study Group. Effect of ramipril vs. amlodipine on renal outcomes in hypertensive nephrosclerosis: a randomized controlled trial J Am Med Assoc 285 2719–2728 Occurrence Handle10.1001/jama.285.21.2719

    Article  Google Scholar 

  53. Effects of ramipril on cardiovascular and Microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. The Heart Outcomes Prevention Evaluation (HOPE) Study Investigators. Lancet 2000; 355: 253–259

  54. L. Hansson (1999) ArticleTitlerecent intervention trials in hypertension initiated in Sweden–HOT, CAPPP and others. Hypertension Optimal Treatment Study. Captopril Prevention Project Clin Exp Hypertens 21 507–515 Occurrence Handle10423077

    PubMed  Google Scholar 

  55. RO Estacio BW Jeffers N Gifford et al. (2000) ArticleTitleEffect of blood pressure control on diabetic microvascular complications in patients with hypertension and type 2 diabetes Diabetes Care 23 IssueIDSuppl.2 B54–64 Occurrence Handle10860192

    PubMed  Google Scholar 

  56. P Tatti M Pahor RP Byington et al. (1998) ArticleTitleOutcome results of the Fosinopril Versus Amlodipine Cardiovascular Events Randomised Trial (FACET) in patients with hypertension and NIDDM Diabetes Care 21 597–603 Occurrence Handle9571349

    PubMed  Google Scholar 

  57. B Pitt W Remme F Zannad et al. (2003) ArticleTitleEplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study Investigators. Eplerenone, a selective aldosterone blocker, in patient with left ventricular dysfunction after myocardial infarction N Engl J Med 348 1309–1321 Occurrence Handle10.1056/NEJMoa030207 Occurrence Handle12668699

    Article  PubMed  Google Scholar 

  58. A Sato K Hayashi M Neruse et al. (2003) ArticleTitleEffectiveness of aldosterone blockade in patients with diabetic nephropathy Hypertension 41 64–68 Occurrence Handle10.1161/01.HYP.0000044937.95080.E9 Occurrence Handle12511531

    Article  PubMed  Google Scholar 

  59. Epstein M, Buckalew V, Martinez F et al and Eplerenone 021 Investigators. Antiproteinuric efficacy of eplerenone, enalapril, and eplerenone/enalapril combination in diabetic hypertensive with microalbuminuria. Am J Hypertens 2002; 15: 24A.

  60. DB Johnson LJ. Dell’Italia (1996) ArticleTitleCardiac hypertrophy and failure in hypertension Curr Opin Nephrol Hypertens 5 IssueID2 186–191 Occurrence Handle8744544

    PubMed  Google Scholar 

  61. AM. Katz (1994) ArticleTitleThe cardiomyopathy of overload: an unnatural growth response in the hypertrophied heart Ann Intern Med 121 IssueID5 363–371 Occurrence Handle8042826

    PubMed  Google Scholar 

  62. ES Stroes EE fassen Particlevan M Yo et al. (2000) ArticleTitleFolic acid reverts dysfunction of endothelial nitric oxide synthase Circ Res 86 1129–1134 Occurrence Handle10850963

    PubMed  Google Scholar 

  63. K Bennett-Richards M Kattenhorn A Donald et al. (2002) ArticleTitleDoes oral folic acid lower total hommocysteine levels and improve endothelial function in children with chronic renal failure? Circulation 105 1810–1815 Occurrence Handle10.1161/01.CIR.0000014417.95833.1D Occurrence Handle11956124

    Article  PubMed  Google Scholar 

  64. TB. Drueke (2002) ArticleTitleTreatment of secondary hyperparathyroidism with vitamin D derivatives and calcimimetics before and after start of dilysis Neprol Dial Transplant 17 IssueIDSuppl. 11 20–22

    Google Scholar 

  65. Herzog CA. Acute myocardial infarction in patients with end-stage renal disease. Kidney Int 1999; (Suppl 71): S130–S133.

  66. Herzog CA, Ma JZ, Collins AJ. Long -term survival of dialysis patients receiving thrombolytic therapy for acute myocardial infarction in the United States. Circulation 1999; (abstr) 100: I–304A.

  67. CA Herzog JZ Ma AJ. Collins (1998) ArticleTitlePoor long-term survival after acute myocardial infarction among patients on long-term dialysis N Engl J Med 339 799–805 Occurrence Handle10.1056/NEJM199809173391203 Occurrence Handle9738087

    Article  PubMed  Google Scholar 

  68. Ryan TJ, Antman EM, Brooks NH et al. 1999 Update: ACE/AHA Guidelines for the Management of Patients with Acute Myocardial Infarction: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). J Am Coll Cardiol. 1999; 34(3): 890–911

    Google Scholar 

  69. CA Herzog JZ Ma AJ. Collins (1999) ArticleTitleLong-term outcome of dialysis patients in the United States with coronary revascularization procedures Kidney Int 56 324–332 Occurrence Handle10.1046/j.1523-1755.1999.00540.x Occurrence Handle10411709

    Article  PubMed  Google Scholar 

  70. CA Herzog JZ Ma AJ. Collins (2002) ArticleTitleComparative survival of dialysis patients in the United States after coronary angioplasty, coronary artery stenting and coronary artery bypass surgery and impact of diabetes Circulation 106 2207–2211 Occurrence Handle10.1161/01.CIR.0000035248.71165.EB Occurrence Handle12390949

    Article  PubMed  Google Scholar 

  71. CA Herzog AZ Ma AJ. Collins (2002) ArticleTitleSurvival of dialysis patients in the United States after precutaneous vs. surgical coronary revascularization: is there a clear choice? J Am Soc Nephrol 13 55

    Google Scholar 

  72. F Gaspari G Vigano S Orisio et al. (1987) ArticleTitleAspirin prolongs bleeding time in uremia by a mechanism district from platelet cycloxygenase inhibition J Clin Invest 79 IssueID6 1788–1797 Occurrence Handle3108321

    PubMed  Google Scholar 

  73. Collaborative overview of randomised trials of antiplatelet therapy – III: reduction in venous thrombosis and pulmonary embolism by antiplatelet prophylaxis among surgical and medical patients. Antiplatelet Trialists’ Collaboration. BMJ 1994; 308(6923): 235-234.

Download references

Author information

Authors and Affiliations

  1. Department of Nephrology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India

    Vikram Kalra, Sandeep Mahajan, Sanjay Kumar Agarwal & Suresh Chander Tiwari

Authors
  1. Vikram Kalra
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sandeep Mahajan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sanjay Kumar Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Suresh Chander Tiwari
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vikram Kalra.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kalra, V., Mahajan, S., Agarwal, S.K. et al. Cardiorenal Disease: A Clinical Intersection. Int Urol Nephrol 37, 175–184 (2005). https://doi.org/10.1007/s11255-004-1561-2

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-004-1561-2

Keywords

Search

Navigation