Cardiovascular risk

Patients with CKD have greatly increased risks of cardiovascular events and cardiovascular deaths. Furthermore, when events occur, their morbidity and mortality is higher. This increased risk begins when there is microalbuminuria even with normal GFR, or when GFR falls below about 50. It is known that the Framingham tables significantly underestimate the risk of cardiovascular disease in patients with CKD.

These observations reinforce the importance of controlling cardiovascular risk factors. Recommendations:


  • Smoking cessation
  • Weight loss
  • Aerobic exercise
  • Limiting salt intake

Control of hypertension

Other prophylaxis

For patients with a 10 year risk of cardiovascular disease of >20% according to the Joint British Guidelines, consider lipid-lowering therapy.

Aspirin should be considered for secondary prevention in patients who have proven cardiovascular disease. It is not contraindicated in renal impairment, but there is a significantly increased risk of bleeding complications for patients on multiple anti-thrombotic agents.

Information for patients

All patients with CKD have a greatly increased risk of developing heart disease and other diseases of blood vessels, including strokes. For many, this is more important than the danger of developing more serious kidney disease.

Blood pressure in renal disease (EdREN) and the links from the foot of that page are useful.



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