Heart Disease is the Most Likely Cause of Death in Chronic Kidney Disease Patients. Let’s Discuss.

When patients come to our clinic to discuss their prognosis, most often their primary concern is when they are going to need to start kidney dialysis. In this article, we will try to explain that although that question is important, and we want to prevent the progression of chronic kidney disease, we must also focus on addressing cardiovascular risk factors. Patients with stage CKD 3 are more likely to die from heart disease than to continue on to stage 4 or 5 chronic kidney disease (CKD). As the kidney function declines, the patient’s heart prognosis worsens.

One of my favorite graphics of all time will help explain the association between kidney disease, age, and death:

A twenty-five-year-old patient with end-stage kidney disease has the same risk of death as an eighty-five-year-old without it. That twenty-five-year-old with end-stage kidney disease has one thousand times more risk than a twenty-five-year-old the same age without kidney disease.

Whether you are white, black, male, female, it does not matter. Chronic kidney disease kills. And the major cause is heart disease. So we need a concerted effort to treat heart disease risk factors and to prevent worsening of CKD. At Lincoln Nephrology and Hypertension, we use a multispecialty approach, involving the players required to give you world class care.

How do we co-manage heart disease risk to prevent cardiac disease in a patient with CKD? We determine which doctor is running which risk factor so that nothing gets missed. Let’s clarify. The following factors are important cardiac risk factors: sugar control if you have diabetes, high cholesterol control, blood pressure control, and protein in the urine. During a visit, I might ask which provider is managing the sugar or which doctor is managing the cholesterol. Although there is usually one provider that leads, more often than not, all the management team contribute to provide excellent care. The key is communication between the patient and the providers.

Repetition can be helpful. Many are not aware that a chronic kidney disease patient in stage 3 is more likely to die from heart disease than progress to stage 4 or 5 CKD. And based on referral patterns in a particular community, we nephrologists may never see that patient. So we think it important that you are aware of risk factors that should be considered to prevent premature death. At the very least, the following should be addressed: diabetes control, hypertension, dyslipidemia, and proteinuria.

So if you have chronic kidney disease, you want to have offered all the options within your means to treat heart disease risk. The options are out there. Options include kidney consultation, medication optimization, and risk stratification (defined as assessing an individual’s risk by ordering tests and providing the “right amount” of healthcare for that individual with the goal of improving the patient’s overall health over time).