What are the clinical manifestations of cardiovascular disease in CKD?
Manifestations of cardiovascular disease include angina pectoris, myocardial infarction, congestive heart failure, stroke, peripheral vascular disease, arrhythmias, and sudden cardiac death.
In advanced CKD, cardiovascular disease is often manifested by left ventricular hypertrophy, diastolic dysfunction, and heart failure. The national registry for dialysis patients—the United States Renal Data System—reports that about 30% of patients with CKD over 66 years of age have congestive heart failure. Left ventricular hypertrophy may be accompanied by left ventricular remodeling and fibrosis, and these changes, with or without coronary artery disease (in addition to electrolyte shifts and volume expansion), may contribute to the high incidence of sudden cardiac death in this population. Indeed, sudden cardiac death is the most common cause of death in dialysis patients.
The clinical manifestations of acute coronary syndrome are also atypical in patients with CKD, and the electrocardiographic findings may be obscured by the presence of left ventricular hypertrophy.
