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Mild to moderate chronic kidney disease and cardiovascular events in patients with type 2 diabetes mellitus

Authors Lessey G, Stavropoulos K, Papademetriou V

Received 2 February 2019

Accepted for publication 1 May 2019

Published 22 August 2019 Volume 2019:15 Pages 365—373


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Takashi Kajiya

Gayatri Lessey,1 Konstantinos Stavropoulos,1,2 Vasilios Papademetriou1,2

1Department of Medicine, Georgetown University Hospital, Washington, DC, USA; 2Department of Medicine, VA Medical Center, Washington, DC, USA

Correspondence: Vasilios Papademetriou
Georgetown University Hospital, 50 Irving St NW, Washington, DC 20422, USA
Tel +1 202 745 8334
Fax +1 202 745 8636

Abstract: Chronic kidney disease (CKD) has become a major public health problem in the USA and worldwide. A large majority of patients with CKD have mild to moderate disease and microalbuminuria. It has increasingly been noted that patients with CKD have a significantly higher risk of cardiovascular outcomes compared to patients with normal kidney function. Many studies have shown increased risk beginning at stage 3 CKD but risk has been elevated in patients with milder degrees of kidney dysfunction in some studies. This risk may be better predicted by the degree of albuminuria in the earlier stages of CKD. Data addressing interventions to improve outcomes in patients with mild to moderate CKD are scarce. In this paper, we examined data and post hoc analyses from the ORIGIN and ACCORD trials. Data indicate that intensive treatment of diabetes in patients with CKD actually may result in adverse outcomes. The mechanism by which CKD results in increased cardiovascular risk is not clear. Patients with CKD frequently have the traditional risk factors that cause cardiovascular disease and there are mechanisms that are unique to CKD that promote the development of cardiovascular disease. In this article, we describe in some detail traditional, newer and novel risk factors that play a role in the development of CKD and heart disease.

Keywords: CKD, CAD, cardiovascular mortality, diabetes mellitus

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