Spectrum of cardiorenal disease

The modern day, worldwide epidemics of obesity and hypertension (HTN) are central drivers of a secondary epidemic of type 2 diabetes with combined chronic kidney disease (CKD) and cardiovascular disease (CVD).' Approximately half of those with diabetes will develop CKD.2 Conversely, half of all cases of end-stage renal disease (ESRD) are due to diabetic nephropathy. With the aging of the general population and cardiovascular care shifting towards the elderly, an understanding of why decreasing levels of renal function act as a major adverse prognostic factor after a variety of cardiac events is imperative. The heart and kidney are inextricably linked via hemodynamic and neurohumoral function (Fig. 1). Considerable evidence shows that CKD accelerates atherosclerosis, myocardial disease, valvular disease, and promotes an array of cardiac arrhythmias.1