Ana Paula Andrade da Silva

By Ana Paula Silva, Anabela Malho Guedes and Pedro Leão Neves

Patients with chronic kidney disease (CKD) are particularly susceptible to cardiovascular complications, and cardiovascular disease (CVD) accounts for more than 50% of all deaths in this population. Cardiac diseases are independently associated with a deterioration of renal function and worsening of existing kidney disease. On the other hand, chronic kidney disease is an independent risk factor for increased cardiovascular morbidity and mortality. It has a complex pathogenesis, and traditional risk factors are not able to fully explain its high incidence and prevalence. Several substances have been identified, and they seem to play important roles in different physiological functions. This chapter will review traditional risk factors such as hypertension, diabetes, dyslipidemia, and left ventricular hypertrophy. The most relevant bibliography will be referred, and also interventional studies will be discussed. Other new emerging factors associated with the osteomineral metabolism have been described, mainly in advanced stages of CKD, and frequently are associated with higher cardiovascular risk, which in turn will contribute to the unfavorable prognosis of this population.

Part of the book: Chronic Kidney Disease

By Eduarda Castanheiro Esteves Carias, Roberto Calças Marques and Ana Paula Andrade da Silva

Cardiovascular disease is the primary cause of morbidity and mortality in chronic kidney disease (CKD) population, particularly in end stage renal disease (ESRD). This could be explained in part due to the presence of traditional cardiovascular risk factors, such as older age, hypertension, dyslipidemia and diabetes, but is also associated with nontraditional cardiovascular risk factors related to CKD, like inflammation, anemia, abnormal calcium and phosphate metabolism and extracellular fluid volume overload, which may contribute to intimal or medial wall arterial calcification. Vascular calcification (VC) is a dynamic process, resulting from the dysregulation of the balance of molecules that promote and those that inhibit this course. It is important for clinicians to both acknowledge and recognize the pathways and risk factors of VC in order to improve cardiovascular health in CKD patients. This chapter will focus on the biology of VC, the association with CKD, risk factor modification, screening and prevention of VC and cardiovascular disease in CKD patients.

Part of the book: Risk Factors for Cardiovascular Disease

By Roberto Calças Marques, Henriques Borges, Rita Afonso, José Soares, Eduarda Carias, Hermínio Carrasqueira and Ana Paula Silva

High resistin levels have been associated with malnutrition, inflammation, and cardiovascular risk in patients with chronic kidney disease (CKD). This study aimed to elucidate the relationship between serum resistin levels and the Patient-Generated Subjective Global Assessment (PG-SGA), a validated nutritional assessment tool in this population. It also investigates the role of resistin as a potential predictor of cardiovascular mortality in early-stage diabetic CKD. Prospective observational study that included 217 type 2 diabetic patients with mild to moderate CKD. Patients were divided into three groups according to PG-SGA: well-nourished (category A), moderately malnourished or suspected of being malnourished (category B), or severely malnourished (category C). The severely malnourished group had higher resistin levels, and resistin was positively correlated with IL-6, PG-SGA score, left ventricular mass index, and pulse pressure, while negatively correlating with vitamin D and estimated glomerular filtration rate (eGFR). We found that high resistin levels (HR = 1.350; 95% CI 1.187–1.535), PG-SGA greater than 10 (HR = 4.858; 95% CI 1.664–14.185), and higher HOMA-IR (HR = 1.099; 95% CI 1.007–4.001) were significant independent predictors of cardiovascular mortality. The study suggests that high resistin levels are associated with malnutrition in mild to moderate CKD and independently predict cardiovascular mortality in this population.

Part of the book: Exploring the Causes and Treatments of Chronic Kidney Disease [Working title]