Cardiac Involvement in Chronic Kidney Disease: Epidemiology, Pathophysiology, and Complications

There is a complex interaction between the heart and kidneys. Cardiac and renal function are both affected physically, chemically, and biologically. In end-stage renal disease (ESRD) patients, cardiovascular disease is the leading cause of mortality. The pathophysiological mechanisms leading to cardiac manifestations in end-stage chronic kidney disease are the decreased oxygen supply to the myocardium, the increased preload, and the left ventricular (LV) afterload alterations. The cardiac complications observed in these patients are LV hypertrophy, myocardial fibrosis, diastolic dysfunction of the left ventricle, coronary artery disease, calcification of the mitral annulus and the aortic valve, and pulmonary hypertension. Several biomarkers that may lead to prevention and early identification of heart complications in these patients are being investigated. In conclusion, the complex relationship between cardiac and renal functions significantly affects patient outcomes in ESRD, highlighting the urgent need for early recognition and intervention strategies to limit cardiovascular complications and improve overall patient care.