REVIEW ARTICLE
Renal function: the Cinderella of cardiovascular risk profile
Luis M. Ruilope, MD*,*,
Dirk J. van Veldhuisen, MD, PhD, FACC ,
Eberhard Ritz, MD, FRCP, FACP and
Thomas F. Luscher, MD, FRCP
* Unidad de Hipertensión, Hospital 12 de Octubre, Madrid, Spain
Department of Cardiology, Thoraxcenter, University Hospital, Groningen, The Netherlands
Department of Internal Medicine, Division of Nephrology, Rupert Karl University, Heidelberg, Germany
Abteilungsleiter Kardiologie, Universität Spital, Zürich, Switzerland
Manuscript received March 20, 2001;
revised manuscript received July 24, 2001,
accepted August 20, 2001.
* Reprint requests and correspondence: Luis M. Ruilope, Unidad de Hipertensión, Hospital 12 de Octubre, 28041 Madrid, Spain
Luis_M_Ruilope{at}teleline.es
The presence of an altered renal function in essential hypertension, advanced heart failure (HF) and after a myocardial infarction (MI) is associated with higher cardiovascular morbidity and mortality. Indices of altered renal function (e.g., microalbuminuria, increased serum creatinine concentrations, decrease in estimated creatinine clearance or overt proteinuria) are independent predictors of cardiovascular morbidity and mortality in any of the three clinical situations. These parameters should then be routinely evaluated in clinical practice. These facts have several therapeutic implications. First, although there is no evidence-based information on the level of blood pressure that confers optimal renal protection, levels substantially lower than past recommendations are advisable. Second, hypertensive kidney damage should be prevented by early treatment of hypertensive patients, particularly those with microalbuminuria. Finally, to avoid further aggravation of high cardiovascular risk, antihypertensive agents devoid of unwanted metabolic side effects should be used for the treatment of hypertensive vascular damage. In HF, the combination of an angiotensin-converting enzyme (ACE) inhibitor and a beta-blocker seem to be the most renoprotective. Renal outcome is also improved by ACE inhibition after an MI. Finally, renal and cardiovascular outcome seem to run in parallel in all these situations.
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Abbreviations and Acronyms
| | ACE | = angiotensin-converting enzyme | | BP | = blood pressure | | CHF | = congestive heart failure | | GFR | = glomerular filtration rate | | HF | = heart failure | | LV | = left ventricle, left ventricular | | LVEF | = left ventricular ejection fraction | | MI | = myocardial infarction | | SCr | = serum creatinine |
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53(7):
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|
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Anemia and Mortality in Heart Failure Patients: A Systematic Review and Meta-Analysis
J. Am. Coll. Cardiol.,
September 2, 2008;
52(10):
818 - 827.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. M. Ruilope and J. Segura
Predictors of the Evolution of Microalbuminuria
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November 1, 2006;
48(5):
832 - 833.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. M. Westerhout, Y. Fu, M. S. Lauer, S. James, P. W. Armstrong, E. Al-Hattab, R. M. Califf, M. L. Simoons, L. Wallentin, E. Boersma, et al.
Short- and Long-Term Risk Stratification in Acute Coronary Syndromes: The Added Value of Quantitative ST-Segment Depression and Multiple Biomarkers
J. Am. Coll. Cardiol.,
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48(5):
939 - 947.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Nitsch, D. F. Dietrich, A. von Eckardstein, J.-M. Gaspoz, S. H. Downs, P. Leuenberger, J.-M. Tschopp, O. Brandli, R. Keller, M. W. Gerbase, et al.
Prevalence of renal impairment and its association with cardiovascular risk factors in a general population: results of the Swiss SAPALDIA study
Nephrol. Dial. Transplant.,
April 1, 2006;
21(4):
935 - 944.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Segura, J. A. Garcia-Donaire, M. Praga, and L. M. Ruilope
Chronic Kidney Disease as a Situation of High Added Risk in Hypertensive Patients
J. Am. Soc. Nephrol.,
April 1, 2006;
17(4_suppl_2):
S136 - S140.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. de Silva, N. P. Nikitin, K. K.A. Witte, A. S. Rigby, K. Goode, S. Bhandari, A. L. Clark, and J. G.F. Cleland
Incidence of renal dysfunction over 6 months in patients with chronic heart failure due to left ventricular systolic dysfunction: contributing factors and relationship to prognosis
Eur. Heart J.,
March 1, 2006;
27(5):
569 - 581.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. L. Hillege, D. Nitsch, M. A. Pfeffer, K. Swedberg, J. J.V. McMurray, S. Yusuf, C. B. Granger, E. L. Michelson, J. Ostergren, J. H. Cornel, et al.
Renal Function as a Predictor of Outcome in a Broad Spectrum of Patients With Heart Failure
Circulation,
February 7, 2006;
113(5):
671 - 678.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J.-P. Collet, G. Montalescot, G. Agnelli, F. Van de Werf, E. P. Gurfinkel, J. Lopez-Sendon, C. V. Laufenberg, M. Klutman, N. Gowda, D. Gulba, et al.
Non-ST-segment elevation acute coronary syndrome in patients with renal dysfunction: benefit of low-molecular-weight heparin alone or with glycoprotein IIb/IIIa inhibitors on outcomes. The Global Registry of Acute Coronary Events
Eur. Heart J.,
November 1, 2005;
26(21):
2285 - 2293.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Segura, J. A. Garcia-Donaire, and L. M. Ruilope
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J. Am. Soc. Nephrol.,
March 1, 2005;
16(3_suppl_1):
S64 - S66.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Hazelton and C. Hickey
Cinderology: the Cinderella of academic medicine
Can. Med. Assoc. J.,
December 7, 2004;
171(12):
1495 - 1496.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. S. Lim, R. J. MacFadyen, and G. Y. H. Lip
Diabetes Mellitus, the Renin-Angiotensin-Aldosterone System, and the Heart
Arch Intern Med,
September 13, 2004;
164(16):
1737 - 1748.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Perticone, R. Maio, G. Tripepi, and C. Zoccali
Endothelial Dysfunction and Mild Renal Insufficiency in Essential Hypertension
Circulation,
August 17, 2004;
110(7):
821 - 825.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C Mueller, F-J Neumann, A P Perruchoud, and H J Buettner
Renal function and long term mortality after unstable angina/non-ST segment elevation myocardial infarction treated very early and predominantly with percutaneous coronary intervention
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August 1, 2004;
90(8):
902 - 907.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. M. Ruilope
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Nephrol. Dial. Transplant.,
March 1, 2004;
19(3):
524 - 528.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Ritz and W. M. McClellan
Overview: Increased Cardiovascular Risk in Patients with Minor Renal Dysfunction: An Emerging Issue with Far-Reaching Consequences
J. Am. Soc. Nephrol.,
March 1, 2004;
15(3):
513 - 516.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. A. Koomans, P. J. Blankestijn, and J. A. Joles
Sympathetic Hyperactivity in Chronic Renal Failure: A Wake-up Call
J. Am. Soc. Nephrol.,
March 1, 2004;
15(3):
524 - 537.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Segura, C. Campo, C. Roldan, H. Christiansen, L. Vigil, R. Garcia-Robles, J. L. Rodicio, and L. M. Ruilope
Hypertensive Renal Damage in Metabolic Syndrome Is Associated with Glucose Metabolism Disturbances
J. Am. Soc. Nephrol.,
January 1, 2004;
15(90010):
S37 - 42.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
S. R. Orth
Effects of Smoking on Systemic and Intrarenal Hemodynamics: Influence on Renal Function
J. Am. Soc. Nephrol.,
January 1, 2004;
15(90010):
S58 - 63.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
G. D. Laverman, G. Remuzzi, and P. Ruggenenti
ACE Inhibition versus Angiotensin Receptor Blockade: Which Is Better for Renal and Cardiovascular Protection?
J. Am. Soc. Nephrol.,
January 1, 2004;
15(90010):
S64 - 70.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
A. O. Ojo, P. J. Held, F. K. Port, R. A. Wolfe, A. B. Leichtman, E. W. Young, J. Arndorfer, L. Christensen, and R. M. Merion
Chronic Renal Failure after Transplantation of a Nonrenal Organ
N. Engl. J. Med.,
September 4, 2003;
349(10):
931 - 940.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J J Santopinto, K A A Fox, R J Goldberg, A Budaj, G Pinero, A Avezum, D Gulba, J Esteban, J M Gore, J Johnson, et al.
Creatinine clearance and adverse hospital outcomes in patients with acute coronary syndromes: findings from the global registry of acute coronary events (GRACE)
Heart,
September 1, 2003;
89(9):
1003 - 1008.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. M Ruilope, J. Segura, and E. L Schiffrin
Review: ACE inhibition or angiotensin receptor blockade: which should we use in diabetic patients?
Journal of Renin-Angiotensin-Aldosterone System,
June 1, 2003;
4(2):
74 - 79.
[Abstract]
[PDF]
|
|
|
|
|
|
|
F. Stam, C. van Guldener, C. G. Schalkwijk, P. M. ter Wee, A. J. M. Donker, and C. D. A. Stehouwer
Impaired renal function is associated with markers of endothelial dysfunction and increased inflammatory activity
Nephrol. Dial. Transplant.,
May 1, 2003;
18(5):
892 - 898.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Ruilope
Proven benefits of angiotensin receptor blockers in the progression of renal disease
Eur. Heart J. Suppl.,
April 1, 2003;
5(suppl_C):
C9 - C12.
[Abstract]
[PDF]
|
|
|
|
|
|
|
M.-S. Sun, C.-J. Pan, J.-J. Shieh, A. Ghosh, L.-Y. Chen, B. C. Mansfield, J. M. Ward, B. J. Byrne, and J. Y. Chou
Sustained hepatic and renal glucose-6-phosphatase expression corrects glycogen storage disease type Ia in mice
Hum. Mol. Genet.,
September 1, 2002;
11(18):
2155 - 2164.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. W. Chan, M. J. Quinn, D. L. Bhatt, D. P. Chew, D. J. Moliterno, E. J. Topol, and S. G. Ellis
Mortality benefit of beta-blockade after successful elective percutaneous coronary intervention
J. Am. Coll. Cardiol.,
August 21, 2002;
40(4):
669 - 675.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. H. Opie and H.-H. Parving
Diabetic Nephropathy: Can Renoprotection Be Extrapolated to Cardiovascular Protection?
Circulation,
August 6, 2002;
106(6):
643 - 645.
[Full Text]
[PDF]
|
|
|
|
