NDT Advance Access originally published online on April 6, 2005
Nephrology Dialysis Transplantation 2005 20(6):1048-1056; doi:10.1093/ndt/gfh813
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Chronic kidney disease as cause of cardiovascular morbidity and mortality
1 Nephrology Section, Department of Internal Medicine, University Hospital, Gent, Belgium, 2 Divisions of Clinical Pharmacology and Nephrology, University of Picardie and Amiens, University Hospital, Amiens, France, 3 Laboratory of Functional Genomics, UPR 2580 of CNRS, Montpellier, France and 4 Department of Nephrology, Clinical Center, University Hospital, Skopje, Macedonia
Correspondence and offprint requests to: Raymond Vanholder, MD, PhD, Nephrology Section, 0K12, University Hospital, De Pintelaan 185, B-9000 Gent, Belgium. Email: raymond.vanholder{at}ugent.be
To make an evidence-based evaluation of the relationship between kidney failure and cardiovascular risk, we reviewed the literature obtained from a PubMed search using pre-defined keywords related to both conditions and covering 18 years (1986 until end 2003). Eighty-five publications, covering 552 258 subjects, are summarized. All but three studies support a link between kidney dysfunction and cardiovascular risk. More importantly, the association is observed very early during the evolution of renal failure: an accelerated cardiovascular risk appears at varying glomerular filtration rate (GFR) cut-off values, which were 
60 ml/min in at least 20 studies. Many studies lacked a clear definition of cardiovascular disease and/or used a single determination of serum creatinine or GFR as an index of kidney function, which is not necessarily corresponding to well-defined chronic kidney disease. In six studies, however, chronic kidney dysfunction and cardiovascular disease were well defined and the results of these confirm the impact of kidney dysfunction. It is concluded that there is an undeniable link between kidney dysfunction and cardiovascular risk and that the presence of even subtle kidney dysfunction should be considered as one of the conditions necessitating intensive prevention of this cardiovascular risk.
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