Table 1

 Primary and secondary cardiovascular disease prevention strategies for patients with chronic kidney disease

Preventive measureRationale
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/m2Resolution of the dysmetabolic syndrome
Prevention of/improvement in diabetes
Aerobic exercise/strength training 30 min/day most days of the weekPrimary/secondary prevention of MI, stroke, and CVD death
Improvement in other risk factors in CKD patients
Low sodium intakeReduce blood pressure
Make blood pressure more responsive to medications
Avoidance of NSAIDSReduced risk of superimposed NSAID nephropathy
Reduced risk of fluid retention and heart failure
Aspirin 81 mg by mouth, four times dailyPrimary/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/lPossible 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 HgPrimary/secondary prevention of MI, stroke, heart failure, and CVD death
    RAS blocking agentsReduce/normalise microalbuminuria
    Add-on treatmentSlow the progression to ESRD and death
Blood glucose control in diabetes to targetReduction 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/lPossible primary/secondary prevention of MI,
    Niacinstroke, and CVD death
    Lipid apheresis
Folic acid, B12, B6 supplementation to normalise (<14 μmol/l) HcyPrimary/secondary prevention of MI, stroke, and CVD death
Sevelamer for combined phosphate and LDL-C lowering in advanced CKD and ESRDAttenuation of progression of coronary calcification by EBCT
Vitamin E 800 IU by mouth, four times daily in ESRDReduce composite CVD events
NAC 600 mg by mouth, twice daily in ESRDReduce composite CVD events