Introduction

Chronic kidney disease (CKD) is a significant health problem. It was estimated that the prevalence of CKD is 8-16% worldwide¹. On the other hand, it is well documented that cardiovascular disease (CVD) is a major cause of morbidity and mortality in patients with CKD^2-6. Thus, although some patients with CKD will ultimately develop end stage renal disease (ESRD), most patients with CKD will die of CVD before dialysis becomes necessary⁷. Mild chronic impaired renal function contributes actively to the development of CVD, so the American Heart Association has recommended that these patients should be classified in the highest risk group for developing cardiovascular events⁵. Even microalbuminuria in the absence of apparent deterioration in renal function or diabetes predicts more CVD and deaths⁸. In patients who finally advance to ESRD and especially dialysis patients, the prevalence of clinical coronary heart disease is 40% and CVD mortality is 10 to 30 times higher than in the general population of the same gender, age and race^5,9,10.

Several factors contribute to atherogenesis and CVD in patients with CKD¹¹. Although most of the cases of coronary heart disease in the general population can be explained by traditional, Framingham risk factors, in patients with CKD, uremia related, non -traditional risk factors, such as, inflammation, oxidative stress, anemia, malnutrition, vascular calcification and endothelial dysfunction have been proposed to play a central role.

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Dr Suman Kumar Singh

Resident, Dept. of General Medicine, M.G.M. Medical College & L.S.K. Hospital, Kishanganj, Bihar