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Cerebrovascular Disease, Cardiovascular Disease, and Chronic Kidney Disease: Interplays and Influences

  • Stroke (B. Ovbiagele, Section Editor)
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Abstract

Purpose of Review

We reviewed reasons for the high cardiovascular risk (CVD) of patients with chronic kidney disease (CKD), and explored alternatives to treatment of traditional risk factors to reduce CVD in CKD.

Recent Findings

Besides traditional risk factors, patients with CKD are exposed to uremic toxins of two kinds: systemically derived toxins include asymmetric dimethylarginine (ADMA), total homocysteine (tHcy), thiocyanate, tumor necrosis factor alpha, and interleukin 6. Gut-derived uremic toxins (GDUT), products of the intestinal microbiome, include hippuric acid, indoxyl sulfate, p-cresyl sulfate, p-cresyl glucuronide, phenylacetylglutamine, and trimethylamine N-oxide (TMAO). Cyanocobalamin is toxic in patients with CKD. Approaches to reducing plasma levels of these uremic toxins would include diet to reduce GDUT, kidney transplantation, more intensive dialysis, and vitamin therapy to lower tHcy with methylcobalamin rather than cyanocobalamin.

Summary

The high CVD risk in CKD requires consideration of therapies beyond treatment of traditional risk factors.

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  1. Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, Western University, 1400 Western Road, London, ON, N6G 2V4, Canada

    J. David Spence

  2. Department of Physiology & Pharmacology, Western University, London, ON, Canada

    Bradley L. Urquhart

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Spence, J.D., Urquhart, B.L. Cerebrovascular Disease, Cardiovascular Disease, and Chronic Kidney Disease: Interplays and Influences. Curr Neurol Neurosci Rep 22, 757–766 (2022). https://doi.org/10.1007/s11910-022-01230-6

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  • DOI: https://doi.org/10.1007/s11910-022-01230-6

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