How many more data is required to give the kidney the attention it deserves? Time to act for the “Big Five” of cardiovascular risk

Abstract

“Do you know your numbers?” became a very frequently asked question over the last decades. Shortly after Christmas or other periods of food overconsumption, the meaning of this question digs like a bulldozer into our brain when we try to avoid to step on the scale assuming that nothing good can be expected. However, it has a much broader sense than just body weight. Numerous campaigns have tried to train people to be aware about classical cardiovascular risk factors, which can be measured on a continuous scale such as cholesterol, blood pressure, blood glucose as well as the "couch-potato syndrome" approximately estimated by body mass index, waist circumference and physical inactivity (Fig. 1). Many of these factors influence each other and thereby tremendously increase their negative potential. For all these factors, there is strong evidence that too high numbers are related to bad outcomes and the various medical professions are campaigning to decrease these numbers with the goal to decrease the number of CVD events. Unfortunately, until now kidney impairment and chronic kidney disease (CKD) did not make it consistently to those numbers. The public and even the clinical awareness for this organ dysfunction remains low [ [1] Ene-Iordache B. Perico N. Bikbov B. et al. Chronic kidney disease and cardiovascular risk in six regions of the world (ISN-KDDC): a cross-sectional study. Lancet Glob Health. 2016; 4: e307-e319 Abstract Full Text Full Text PDF PubMed Scopus (265) Google Scholar ]. This is surprising considering that the prevalence and incidence are increasing globally [ [2] Eckardt K.U. Coresh J. Devuyst O. et al. Evolving importance of kidney disease: from subspecialty to global health burden. Lancet. 2013; 382: 158-169 Abstract Full Text Full Text PDF PubMed Scopus (743) Google Scholar ] and CKD is one of the leading causes of death [ [3] Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017; 390: 1151-1210 Abstract Full Text Full Text PDF PubMed Scopus (2943) Google Scholar ] with an increasing tendency in the disease-attributable mortality [ [4] Jha V. Garcia-Garcia G. Iseki K. et al. Chronic kidney disease: global dimension and perspectives. Lancet. 2013; 382: 260-272 Abstract Full Text Full Text PDF PubMed Scopus (2575) Google Scholar ]. Chronic kidney disease and outcomes of lower extremity revascularization for peripheral artery diseaseAtherosclerosisVol. 297PreviewRenal disease is a risk factor for peripheral artery disease (PAD), yet its impact on outcomes after lower extremity (LE) revascularization is not well established. We aimed to characterize the association between chronic kidney disease (CKD) and/or end stage renal disease (ESRD) and post-procedural outcomes in PAD patients undergoing LE revascularization in the United States. Full-Text PDF