Chronic Kidney Disease

CKD: Hypertension and Hyperlipidemia (2001)

This evidence analysis project was updated in 2008-09.  Click here to view the revised/updated ADA Chronic Kidney Disease (CKD) Evidence Analysis Project. 

Prevention of Cardiovascular Disease: Hypertension and Hyperlipidemia (2001)

unpublished June 6 2011

• Assessment
  What is the relationship between chronic kidney disease and hypertension and hyperlipidemia? (2001 CD)

  • Conclusion

    The prevalence of hypertension and hyperlipidemia with risk for cardiovascular disease, coronary artery disease, and left ventricular hypertrophy is higher in chronic kidney disease compared to the general population. Aggressive treatment of hypertension with a goal of <135/85 mm Hg without proteinuria and <125/75 mm Hg with proteinuria >1g protein/24 hours with medications and restriction of dietary sodium to 1 to 3 g per day will slow the progression of kidney disease and reduce the risk of cardiovascular disease. Serum potassium should be monitored because of the effect of some antihypertensive agents on potassium excretion.

     

     

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Prevention of Cardiovascular Disease in Chronic Kidney Disease (2001)
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Bakris GL, Siomos M, Richardson D, Janssen I,  Bolton WK, Hebert L, Agarwal R, Catanzaro D. ACE inhibition or angiotensin receptor blockade: Impact on potassium in renal failure.  Kidney Int 2000; 58:2084-2092.
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      • Cianciaruso B, Bellizzi V, Minutolo R, Tavera A, Capuano A, Conte G, De Nicola L. Salt intake and renal outcome in patients with progressive renal disease.  Miner Electrolyte Metab 1998;24:296-301.
      • Culleton BF, Larson MG, Wilson PWF, Evans JC, Parfrey PS, Levy D.  Cardiovascular disease and mortality in a community-based cohort with mild renal insufficiency.  Kidney Int 1999; 56:2214-2219.  
      • Ellis D, Lloyd C, Becker DJ, Forrest KY, Orchard TJ. The changing course of diabetic nephropathy: low-density lipoprotein cholesterol and blood pressure correlate with regression of proteinuria. Am J Kidney Disease 1996;27:809-818.  
      • Fried LF, Orchard TJ, Kasiske BL.  Effect of lipid reduction on the progression of renal disease: A meta-analysis. Kidney Int 2001; 59:260-269.  
      • Irvin B. The progression and treatment of diabetic nephropathy. Top Clin Nutr 1996; 12:31-40.
      • Jungers P, Massy ZA, Khoa TN, Fumeron C, Labrunie M, Lacour B, Descamps-Latscha B, Man NK.  Incidence and risk factors of atherosclerotic cardiovascular accidents in predialysis chronic renal failure patients:  a prospective study.  Nephrol Dial Transplant 1997;12:2597-2602.
      • Kasiske BL.  Hyperlipidemia in patients with chronic renal disease.  Am J Kidney Dis 1998;32 (Suppl 3):S142-S156. 
      • Keane WF, Eknoyan G. Proteinuria, albuminuria, risk, assessment, detection, elimination (PARADE): A position paper of the National Kidney Foundation.  Am J Kidney Diseases 1999; 33:1004-1010.  
      • Mailloux LU, Levey AS. Hypertension in patients with chronic renal disease.  Am J Kidney Diseases 1998; 32(Suppl 3): S120-S141. 
      • Muirhead N. The rationale for early management of chronic renal insufficiency. Nephrol Dial Transplant 2001;16 (suppl 7): 51-56.  
      • Stenvinkel P, Heimburger O, Paultre F, Diczfalusy U, Wang T, Berglund L, Jogestrand T.  Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int 1999; 55:1899-1911.
      • Weir MR. Impact of salt intake on blood pressure and proteinuria in diabetes:  importance of the renin-angiotensin system.  Miner Electrolyte Metab 1998; 24:438-445.  
      • Yamamoto ME, Olson MB, Fine J, Powers S, Stollar C. The effect of sodium restriction and weight reduction on blood pressure of patients with hypertension and chronic renal disease. J Renal Nutr. 1997; 7: 25-32.