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How Does Minor Renal Dysfunction Influence Cardiovascular Risk and the Management of Cardiovascular Disease?

Tobias Pinkau^*, Karl F. Hilgers, Roland Veelken and Johannes F. E. Mann

*Department of Cardiology, German Heart Center, Munich, Germany; Department of Nephrology, University of Erlangen-Nuremberg, Erlangen, Germany; and Department of Nephrology and Hypertension, Schwabing General Hospital, Munich, Germany.

Correspondence to Dr. Johannes F. E. Mann, Professor of Medicine, Department of Nephrology and Hypertension, Schwabing General Hospital, Kolner Platz 1, Munchen 80804, Germany. Phone: 49893068-2386; Fax: 49893068-3917; E-mail: johannes.mann{at}kms.mhn.de

ABSTRACT. This review focuses on the association between mild renal insufficiency (stage 2 and 3 of chronic kidney disease) 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 is now established as an independent risk for atherosclerotic cardiovascular disease. The association has been established in patients with a high cardiovascular risk but also in the general population. 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 minor renal dysfunction, but there is still an underutilization of coronary revascularization procedures in people with renal insufficiency. The use of coronary stenting has now reduced the incidence of restenosis in these patients, and there is hope that the development of new devices will improve the prognosis in patients with renal insufficiency as well. Nevertheless, people with cardiovascular disease and renal insufficiency die significantly more often than people without renal insufficiency independent of prior successful treatment. Further investigations should focus on the causes of and possible preventive interventions for the staggering cardiovascular risk in the ever-increasing number of people with minor renal dysfunction.

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673