Role of chronic kidney disease in cardiovascular disease: are we different from others?

Abstract

The incidence and prevalence of chronic dialysis patients in Japan is increasing linearly and is currently as high as 300 and 2300 per million population, respectively. The incidence of end-stage renal disease is closely related to that of chronic dialysis; findings which are captured in detail in the Japanese Society for Dialysis Therapy registry. Life expectancy of dialysis patients is poor compared to the age- and sex-matched general population, and is equivalent to that of an 80-year-old man or an 87-year-old woman, i.e., dialysis patients seem 15–18 years older than their actual age. Cardiac death is the leading cause of death; however, death due to stroke and acute myocardial infarction is decreasing. The annual mortality rate is 6.5% among the dialysis population. For the past 10 years, the mortality risk has remained high despite the avoidance of blood transfusions by the administration of erythropoiesis-stimulating agents, the use of renin−angiotensin system inhibitors, and improvements in general medical care. Several studies have confirmed the significance of chronic kidney disease (CKD) on the development of cardiovascular disease (CVD) and mortality; the lower the estimated glomerular filtration rate (eGFR), the higher the incidence of CVD. The cut-off levels for eGFR are not yet clear. CKD is an important predictor of CVD in Japan, similar to other parts of the world. Strategies for early detection of CKD are needed because, in many cases, CKD remains asymptomatic until late stages. Timely treatment for CKD is necessary to minimize costs for unnecessary care and testing. Unless CDK is properly managed, it will not be possible to maintain quality and longevity of life. The Japanese population is rapidly aging and will have the largest proportion of elderly people in the world. A systematic strategy for managing CKD patients is warranted.