Contribution of Chronic Kidney Disease to Cardiovascular Disease Within the Cardiorenal–Metabolic Continuum

Abstract

Chronic kidney disease is a global public health problem characterized by high prevalence, underdiagnosis, and substantial morbidity and mortality, primarily driven by cardiovascular outcomes. It is currently recognized as a major independent risk factor for both atherosclerotic and non-atherosclerotic cardiovascular disease, with risk increasing in parallel with declining glomerular filtration rate and rising albuminuria. This association is explained by the synergistic interaction between traditional cardiovascular risk factors and non-traditional pathophysiological mechanisms that are highly prevalent in chronic kidney disease. These include mineral and bone disorder, anemia, volume overload, uremic toxins, oxidative stress, chronic inflammation, dysbiosis, and overactivation of the renin–angiotensin–aldosterone system and the sympathetic nervous system. Collectively, these processes promote endothelial dysfunction, accelerated atherosclerosis, and maladaptive cardiac remodeling, ultimately contributing to the high cardiovascular morbidity and mortality observed in this population.