CHAPTER 15b Cardiovascular Problems in Chronic Kidney Disease
Until recently, impaired kidney function was an orphan in the cardiological assessment of patients with heart disease, while in patients with chronic kidney disease (CKD) cardiological assessment was not considered a high priority. However, impressive evidence has now been provided that cardiovascular problems critically determine life expectancy of patients with CKD.Cardiological examination of patients with advanced CKD should be obligatory. Importantly, invasive diagnostic workup and revascularization procedures should not be withheld in CKD patients presenting with myocardial ischaemia.
Conversely, in cardiac patients appropriate assessment of renal function employing modern methodology (estimated glomerular filtration rate, albuminuria) is obligatory as well, since kidney function critically determines systemic neurohumoral activation.
In the management of renal patients the most important aspect is appropriate control of blood pressure, but cardiovascular prevention in these patients comprises the full spectrum of beta blockade, blockade of the renin–angiotensin–aldosterone system, aspirin, and statins.
Chapter 28)
