Primary and secondary cardiovascular disease prevention strategies for patients with chronic kidney disease
| Preventive measure | Rationale |
|---|---|
| BMI, body mass index; CKD, chronic kidney disease; CVD, cardiovascular disease; EBCT, electron beam computed tomography; ESRD, end stage renal disease; Hcy, homocysteine; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; MI, myocardial infarction; NAC, N-acetylcysteine; NSAIDS, non-steroidal anti-inflammatory drugs; RAS, renin–angiotensin system; SBP, systolic blood pressure; TG, triglycerides. | |
| Generally accepted | |
| Weight loss/weight maintenance at BMI ⩽25 kg/m2 | Resolution of the dysmetabolic syndrome |
| Prevention of/improvement in diabetes | |
| Aerobic exercise/strength training 30 min/day most days of the week | Primary/secondary prevention of MI, stroke, and CVD death |
| Improvement in other risk factors in CKD patients | |
| Low sodium intake | Reduce blood pressure |
| Make blood pressure more responsive to medications | |
| Avoidance of NSAIDS | Reduced risk of superimposed NSAID nephropathy |
| Reduced risk of fluid retention and heart failure | |
| Aspirin 81 mg by mouth, four times daily | Primary/secondary prevention of MI and stroke |
| Lipid control (diet, statin, fibrates, niacin, others) | Primary/secondary prevention of MI, stroke, and CVD death |
| LDL-C <2.6 mmol/l | Possible reduction in progression of CKD |
| TG <1.7 mmol/l | |
| HDL-C >1.3 mmol/l | |
| Blood pressure control to optimal target of SBP <120 mm Hg | Primary/secondary prevention of MI, stroke, heart failure, and CVD death |
| RAS blocking agents | Reduce/normalise microalbuminuria |
| Add-on treatment | Slow the progression to ESRD and death |
| Blood glucose control in diabetes to target | Reduction in risk of MI, stroke, and CVD death |
| glycohaemoglobin <7% | Reduction in worsened nephropathy/retinopathy |
| Experimental—limited supportive evidence | |
| Reduce/normalise Lp(a) <1.1 mmol/l | Possible primary/secondary prevention of MI, |
| Niacin | stroke, and CVD death |
| Lipid apheresis | |
| Folic acid, B12, B6 supplementation to normalise (<14 μmol/l) Hcy | Primary/secondary prevention of MI, stroke, and CVD death |
| Sevelamer for combined phosphate and LDL-C lowering in advanced CKD and ESRD | Attenuation of progression of coronary calcification by EBCT |
| Vitamin E 800 IU by mouth, four times daily in ESRD | Reduce composite CVD events |
| NAC 600 mg by mouth, twice daily in ESRD | Reduce composite CVD events |