Beyond (or Back to) Traditional Risk Factors: Preventing Cardiovascular Disease in Patients with Chronic Kidney Disease

Patients with chronic kidney disease carry an extraordinarily high risk for cardiovascular disease (CVD). In fact, most patients with chronic kidney disease will die of CVD before reaching end-stage kidney disease (1). A logical starting point for CVD prevention efforts in this population is determining the extent to which traditional CVD risk factors (that is, smoking, blood pressure, diabetes, and hypercholesterolemia) are responsible for the excess risk for CVD. In this issue, Muntner and colleagues (2) highlight the possibility that other risk factors, commonly termed nontraditional risk factors, also contribute to the burden of CVD in this population.

The setting is the Third National Health and Nutrition Examination Survey. In this large, representative survey of more than 15 000 noninstitutionalized U.S. adults, participants were stratified by level of estimated glomerular filtration rate. The highest category (≥ 90 mL/min per 1.73 m²) included healthy persons and those with stage 1 chronic kidney disease, the intermediate category (60 to 89 mL/min per 1.73 m²) corresponded to stage 2, and the lowest category (15 to 59 mL/min per 1.73 m²) corresponded to stages 3 and 4 (3).

The principal finding of this well-done study is a high prevalence of nontraditional CVD risk factors among persons with chronic kidney disease. In brief, the lowest level of kidney function was associated with a higher prevalence of detectable C-reactive protein; elevated C-reactive protein levels; high levels of plasma fibrinogen, homocysteine, and lipoprotein(a); and low levels of apolipoprotein A1. While there was …