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Abstract
The risk for cardiovascular disease (CVD) morbidity and mortality remains alarmingly
high in all stages of chronic kidney disease (CKD). CVD often begins before end-stage
renal disease (ESRD), and patients with reduced kidney function are more likely to
die of CVD than to develop ESRD. Three pathological forms of CVD should be considered
in patients with CKD: alterations in cardiac geometry, including left ventricular
hypertrophy, atherosclerosis, and arteriosclerosis. All are highly prevalent in patients
with CKD. Although patients with CKD share many of the same risk factors for CVD as
the general population, there are a number of uremia-related risk factors, such as
anemia and alterations in calcium/phosphorus metabolism, that also play a role in
promoting CVD. Treatment of both traditional and uremia-related risk factors should
be initiated in the earlier stages of CKD. Additional clinical trials with a goal
to reduce CVD are urgently needed in CKD.