Approaches to maximize cardiovascular risk reduction in people with kidney disease Sheldon Tobe

The National Kidney Foundation (NKF) has recently set specific definitions for different stages of kidney disease based on the GFR as estimated from the serum creatinine level (see Table 5.1).1 The use of stages rather than descriptive terms, such as mild/moderate and severe, is consistent with the Joint National Committee on Hypertension’s (JNC VI) sixth

report where blood pressure levels were also divided into stages. Renal function like blood pressure is a continuum but dividing it into specific stages helps to split people with chronic kidney disease (CKD) into identifiable groups. These groups are useful as they are associated with increasing symptomatology, increasing risk for end-stage renal disease (ESRD) and also for cardiovascular disease. The size of the

Definition of kidney disease • Epidemiology of cardiovascular disease in those with renal disease • What are the risk factors for cardiovascular events in patients with renal disease? • Hypertension • Diabetes • Dyslipidemia • Smoking • Anemia • Left ventricular Hypertrophy (LVH) • Thrombotic and inflammatory markers including TGF-Beta • Proteinuria and albuminuria • Homocysteine (hcy) • References

Table 5.1 Definition and stages of chronic kidney disease

Stage Desciption GFR (mL/min/1.73 m2)

1 Kidney damage with normal or higher GFR ≥90 2 Kidney damage with mildly lower GFR 60-89 3 Moderately lower GFR 30-59 4 Severely lower GFR 15-29 5 Kidney failure 15 (or dialysis)

population of those with severe renal disease, (GFR 15-29 ml/min stage 4 CKD) is approximately the same size as those with ESRD (stage 5 CKD) and is much smaller than the population that has stage 3 CKD (GFR 30-59 ml/min) (see Table 5.2).