Ten hot topics in cardiovascular risk management for chronic kidney disease

Fig. 1.. Both decreased GFR and increased UACR are independently associated with increased cardiovascular risk. GFR, glomerular filtration rate; UACR, urinary albumin-to-creatinine ratio; eGFR, estimated glomerular filtration rate.

Fig. 2.. Decreased GFR and/or increased UACR may result in loss of homeostasis or gerosuppressor function that trigger diverse forms of CVD. Some key relationships have been highlighted. However, the actual pathophysiology is more complex than shown. GFR, glomerular filtration rate; AF, atrial fibrillation; PAD, peripheral artery disease; LVH, left-ventricular hypertrophy; PTC, proximal tubular cell; CV, cardiovascular; UACR, urinary albumin-to-creatinine ratio; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; EPO, erythropoietin; HDL, high density lipoprotein-cholesterol; Lp(a), lipoprotein (a); PTC, proximal tubule cells; CVD, cardiovascular disease, PTH, parathormone; FGF23, fibroblast growth factor 23.

Fig. 3.. Multimodal vascular assessment in CKD. Panel A illustrates the anatomical sites and pathological thresholds of four non-invasive tests used to assess arterial tree in CKD. Panel B provides a practical guide to selecting these tests based on GFR and albuminuria categories, with suggested testing intervals according to cardiovascular risk. This approach supports early identification of vascular aging and personalization of preventive strategies. CKD, chronic kidney disease; PWV, pulse wave velocity; ABI, ankle-brachial index; PAD, peripheral artery disease; MAC, medial arterial calcification; cIMT, carotid intima-media thickness; CAC, coronary artery calcium; GFR, glomerular filtration rate.

Fig. 4.. Non-pharmacological interventions to reduce cardiovascular risk in patients with CKD.

Fig. 5.. Proposed algorithm for the management of dyslipidemia in CKD based on current guidelines and consensus documents [20, 24, 33, 81] aIf LDL-C is between ≥70 and 100 mg/dL, add bempedoic acid as preferred therapy on top of statins+ezetimibe. bIf LDL-C ≥100 mg/dL, add PCSK9-tt as preferred therapy on top of statins+ezetimibe. CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; Lp(a), lipoprotein(a); LDL-c, low-density lipoprotein-cholesterol; PCKS9, proprotein convertase subtilisin/kexin type 9.