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Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jul 15, 2021; 12(7): 975-996
Published online Jul 15, 2021. doi: 10.4239/wjd.v12.i7.975
Diabetic patients with chronic kidney disease: Non-invasive assessment of cardiovascular risk
Nejc Piko, Sebastjan Bevc, Robert Ekart, Tadej Petreski, Nina Vodošek Hojs, Radovan Hojs
Nejc Piko, Robert Ekart, Department of Dialysis, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor 2000, Slovenia
Sebastjan Bevc, Tadej Petreski, Nina Vodošek Hojs, Radovan Hojs, Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor 2000, Slovenia
Sebastjan Bevc, Robert Ekart, Tadej Petreski, Radovan Hojs, Medical Faculty, University of Maribor, Maribor 2000, Slovenia
Author contributions: Piko N, Bevc S and Hojs R contributed to the conception and design of the manuscript; Piko N, Bevc S, Hojs R, Petreski T, Vodošek Hojs N and Ekart R drafted the article, made critical revisions related to the manuscript and approved the final version of the manuscript to be published.
Conflict-of-interest statement: The authors declare no conflict of interest exists. This article has previously not been published elsewhere in any shape or form.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Radovan Hojs, MD, PhD, Professor, Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Ljubljanska 5, Maribor 2000, Slovenia. radovan.hojs@guest.arnes.si
Received: January 26, 2021
Peer-review started: January 26, 2021
First decision: February 25, 2021
Revised: March 4, 2021
Accepted: April 26, 2021
Article in press: April 26, 2021
Published online: July 15, 2021
Processing time: 166 Days and 13.7 Hours
Abstract

The prevalence and burden of diabetes mellitus and chronic kidney disease on global health and socioeconomic development is already heavy and still rising. Diabetes mellitus by itself is linked to adverse cardiovascular events, and the presence of concomitant chronic kidney disease further amplifies cardiovascular risk. The culmination of traditional (male gender, smoking, advanced age, obesity, arterial hypertension and dyslipidemia) and non-traditional risk factors (anemia, inflammation, proteinuria, volume overload, mineral metabolism abnormalities, oxidative stress, etc.) contributes to advanced atherosclerosis and increased cardiovascular risk. To decrease the morbidity and mortality of these patients due to cardiovascular causes, timely and efficient cardiovascular risk assessment is of huge importance. Cardiovascular risk assessment can be based on laboratory parameters, imaging techniques, arterial stiffness parameters, ankle-brachial index and 24 h blood pressure measurements. Newer methods include epigenetic markers, soluble adhesion molecules, cytokines and markers of oxidative stress. In this review, the authors present several non-invasive methods of cardiovascular risk assessment in patients with diabetes mellitus and chronic kidney disease.

Keywords: Diabetes mellitus; Diabetes complications; Chronic kidney disease; Atherogenesis; Atherosclerosis; Cardiovascular risk

Core Tip: The culmination of traditional and non-traditional atherosclerosis risk factors in patients with diabetes mellitus and chronic kidney disease leads to fulminant and advanced atherosclerosis, consequently resulting in cardiovascular morbidity and mortality. Non-invasive cardiovascular risk assessment should therefore be performed in all these patients and can be based on standard laboratory parameters, cytokines and markers of oxidative stress, 24 h blood pressure measurements, ankle-brachial index, arterial stiffness parameters, imaging techniques and epigenetic markers. In this review article, we present different methods of non-invasive cardiovascular risk assessment in patients with diabetes mellitus and chronic kidney disease.