Heart Patients Should Be Screened for Kidney Disease

Chronic kidney disease (CKD) is a risk factor for the development and progression of cardiovascular disease. Therefore patients with cardiovascular disease should be screened for evidence of kidney disease.

Patients with cardiovascular disease and suspected chronic kidney disease need more sensitive diagnostic tools than serum creatinine alone. In an American Heart Association (AHA) advisory statement published in the August 7, 2006, online edition of the journal Circulation, cardiologists recommended that physicians go beyond serum creatinine to evaluate kidney function. According to the AHA, the Modification of Diet in Renal Disease (MDRD) equation to detect glomerular filtration rate should be combined with the albumin-to-creatinine ratio.

Recent studies have confirmed that even early stages of renal dysfunction significantly increase the risk of cardiovascular events and death, the AHA statement noted. In addition, treatment regimens are available to delay the progression of chronic kidney disease and manage its complications such as anemia and bone disease.

"Many people use the serum creatinine,” wrote Frank C. Brosius III, M.D., of the University of Michigan in Ann Arbor (Ann Arbor, MI, USA), and colleagues. "If their patients are within the normal range then they don't recognize that their kidney function is decreased.” The Modification of Diet in Renal Function equation calculates glomerular filtration rate, which is the most accurate index of kidney function, using the serum creatinine and albumin levels, age, gender, blood urea nitrogen, and whether the patient is black. This equation "is currently the best validated method to estimate [glomerular filtration rate] for adults in the typical office setting.”

Finding the presence of chronic kidney disease may change the treatment intensity and monitoring strategy as well as the use of agents required for the management of renal disease. Both the frequency of cardiovascular complications and the progression of chronic kidney disease can be ameliorated in these patients by appropriate intervention.



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University of Michigan in Ann Arbor