Why do young people with chronic kidney disease die early?

Abstract

Cardiovascular disease poses the greatest risk of premature death seen among patients with chronic kidney disease (CKD). Up to 50% of mortality risk in the dialysis population is attributable to cardiovascular disease and the largest relative excess mortality is observed in younger patients. In early CKD, occlusive thrombotic coronary disease is common, but those who survive to reach end-stage renal failure requiring dialysis are more prone to sudden death attributable mostly to sudden arrhythmic events and heart failure related to left ventricular hypertrophy, coronary vascular calcification and electrolyte disturbances. In this review, we discuss the basis of the interaction of traditional risk factors for cardiovascular disease with various pathological processes such as endothelial dysfunction, oxidative stress, low grade chronic inflammation, neurohormonal changes and vascular calcification and stiffness which account for the structural and functional cardiac changes that predispose to excess morbidity and mortality in young people with CKD.

Keywords: Chronic kidney disease; Cardiovascular mortality; Cardiorenal syndrome; Endothelial dysfunction; Vascular calcification and stiffness

Core tip: In this review, we set out to summarise current opinion based on extensive scientific research that might explain the reasons for the disproportionately high death rate in chronic kidney disease and dialysis patients. The cardiovascular “phenotype” that poses increased risk to patients with chronic kidney disease (CKD) changes with progression of kidney dysfunction. Macrovascular disease is more important in early CKD whereas microvascular processes play an increasing role with worsening kidney disease.