Module 10: Hypertension and Kidney Disease Study Questions

Question 1

How common is CVD in the CKD population?

Answer 1

In the CKD population, CVD is 2X as common when compared to the general population and advances at 2X the rate of the underlying CKD

Question 2

How does CKD influence the development and severity of CVD? Specifically – what is the role of traditional and non-traditional risk factors such as hypertension, dyslipidemia, oxidative stress, inflammation and altered calcium-phosphate metabolism in the CKD-CVD interplay.

Answer 2

Hypertension and inflammation:
- CKD results in salt and fluid retention and thus can worsen pre-existing hypertension and induce and inflammatory response.

Dyslipidemia:
- CKD is associated with metabolic abnormalities leading to a deranged cholesterol profile.

Inflammation and oxidative stress:
- CKD itself is responsible for a host of non-traditional risk factors such as Anemia, electrolyte and Mineral metabolism derangements, increased Inflammation, as well as the buildup of Uremic toxins, and Enhanced oxidative stress.

Oxidative stress:
- CKD leads to low EPO -> Anemia -> Oxidative stress -> LV hypertrophy and then LV dilatation and heart failure

Calcium-phosphate metabolism:
- Early in CKD - phosphorus levels increase due to reduction in renal clearance. Conversely calcium levels decrease due to decreased calcitriol synthesis with resultant decreased calcium absorption from the gut and decreased calcium release from bone (Vit D deficiency). As CKD progresses, these low plasma calcium levels place increased demand on the parathyroid gland resulting in hyperplasia, elevated PTH and ultimately, the development of secondary hyperparathyroidism (SHPT). This combination predisposes patients to malignant calcification of tissues but also blood vessels, myocardium, and cardiac valves.

Question 3

What is the blood pressure and lipid target for patients with CKD?

Answer 3

• Hypertension should be aggressively managed to a target blood pressure of less than 130/80.
• Cholesterol should be managed aggressively to high risk targets. Generally speaking, lifestyle measures are first line for abnormalities of triglycerides and HDL however pharmacotherapy with a fibrate or statin may be required

Question 4

What role does albuminuria play in the assessment and prognostication of CVD in patients with CKD?

Answer 4

spot urine albumin:Cr can allow us to identify patients at risk early