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

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

Automated summary

This review examines the reasons for the high cardiovascular risk in patients with chronic kidney disease (CKD) and explores alternative treatments to reduce cardiovascular disease (CVD) in CKD. In addition to traditional risk factors, CKD patients are exposed to uremic toxins, including systemically derived toxins and gut-derived uremic toxins. Approaches to reducing these uremic toxins include diet, kidney transplantation, more intensive dialysis, and vitamin therapy.