Chronic Kidney Disease and Cardiovascular Risk: The Clinical Link That Patients Are Often Not Told About

Halton Pharmacy’s Cardiac Health Hub in Leeds reflects a clinical philosophy that cardiovascular disease is a systemic condition requiring a comprehensive view of interconnected risk factors, not a collection of separate diagnoses managed in isolation. Chronic kidney disease (CKD) sits at a particularly important intersection within this framework: it is one of the most powerful and most frequently underappreciated independent risk factors for cardiovascular disease, and the relationship between kidney function and heart health is bidirectional in ways that have direct implications for how both conditions should be managed.

The Scale of CKD: A Largely Silent Condition

Chronic kidney disease is defined as an abnormality of kidney structure or function, present for more than three months, as evidenced by a reduced estimated glomerular filtration rate (eGFR below 60 mL/min/1.73m²) or markers of kidney damage including albuminuria. It affects approximately 7.2 million adults in the UK (stages 1-5), and in the vast majority of cases produces no symptoms until the disease is advanced. The first indication that many patients have CKD is a blood test result showing abnormal eGFR or the presence of protein in the urine.

The causes of CKD overlap substantially with cardiovascular risk factors: diabetes mellitus and hypertension are the two most common causes of CKD in the UK, accounting for the majority of cases. Glomerulonephritis, polycystic kidney disease, and recurrent urinary tract infections are less common causes. Because CKD and cardiovascular disease share so many risk factors, their co-occurrence is common, and managing one without considering the other represents an incomplete approach to patient care.

Why CKD Independently Raises Cardiovascular Risk

The mechanisms by which CKD increases cardiovascular risk are multiple and include:

• • Hypertension: impaired renal sodium excretion and activation of the renin-angiotensin-aldosterone system (RAAS) in CKD drives blood pressure elevation, which itself damages both the kidneys and the cardiovascular system in a self-amplifying cycle

• • Anaemia of CKD: reduced erythropoietin production from diseased kidneys causes anaemia, which increases cardiac workload and contributes to left ventricular hypertrophy

• • Mineral and bone disorder: dysregulation of calcium, phosphate and FGF-23 in CKD promotes vascular calcification, stiffening the arterial wall and increasing afterload on the left ventricle

• • Uraemic toxins: accumulation of nitrogenous waste products and other uraemic toxins impairs endothelial function and promotes platelet aggregation and thrombosis

• • Dyslipidaemia: CKD alters lipid metabolism, producing a pattern of raised triglycerides and reduced HDL cholesterol that adds to atherogenic risk

In practical terms, individuals with an eGFR below 30 mL/min/1.73m² (stage 4 CKD) have a cardiovascular mortality risk comparable to individuals who have already had a myocardial infarction, even in the absence of traditional cardiovascular risk factors. This makes CKD an extremely high-risk condition from a cardiovascular perspective, justifying aggressive risk factor management.

The Role of SGLT2 Inhibitors: A Paradigm Shift

One of the most clinically significant advances in CKD management in recent years has been the demonstration that SGLT2 inhibitors (flozins), medications originally developed for type 2 diabetes, have reno-protective and cardioprotective effects in patients with CKD regardless of whether they have diabetes. Trials including DAPA-CKD (dapagliflozin) and CREDENCE (canagliflozin) demonstrated significant reductions in CKD progression, hospitalisation for heart failure, and cardiovascular death in patients with CKD receiving SGLT2 inhibitor therapy.

This evidence has led to a substantial revision of CKD management guidelines, with SGLT2 inhibitors now recommended across a much broader CKD population. Community pharmacists play an important role in supporting adherence to these medications, monitoring for side effects, and ensuring patients understand the renal and cardiovascular rationale for treatment that may have initially been prescribed for diabetes.

This article is for general information and does not constitute individual clinical advice. Please speak with our clinical team at Halton Pharmacy for a personalised risk assessment.