Arterial hypertension, chronic kidney disease and cardiovascular risk

In Spain, 6.8% of the adult population is diagnosed with CKD. The general profile is of individuals with high cardiovascular risk and of advanced age. Most of them are diabetic, have high blood pressure, many are obese and have high cholesterol. There is also an increase in the number of patients who start renal replacement therapy.

Arterial hypertension can affect us in more areas than we might think.

Arterial hypertension is the cause and consequence of the development not only of renal failure, but also of cardiovascular pathologies such as myocardial infarction, cardiac failure and arrhythmias, cerebrovascular accidents or rupture of aneurysms, which aggravates arteriosclerosis and leads to high morbidity and mortality. Early diagnosis is a priority in order to assess potentially treatable triggering causes, target organ involvement and correct treatment.

In general, the most recent guidelines recommend maintaining systolic and diastolic blood pressure levels below 140/90mmHg for all age groups, being more permissive at 150/90mmHg for people over 60 years of age. As a member of the Spanish Society of Nephrology, I would like to remind you that nephrologists are the specialists most accustomed to the prevention, diagnosis and treatment of arterial hypertension.

Chronic Kidney Disease occurs when there is structural or functional damage to the kidneys. When this function is below 60% of the filtration rate, we say that there is renal failure.

As the disease progresses and the filtration rate is reduced, complications appear such as anemia of renal origin, fluid overload, hypertension, alterations in bone and mineral metabolism with accumulation of urea and potassium that can compromise the patient’s life. It is a disease that cannot be cured, so diagnosis and prevention are key to avoid the progression of renal disease.

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What is a renal diagnosis and how is it performed?

The diagnosis is simple, with a blood test, measuring creatinine levels and a urinalysis where alterations in urinary concentration, albumin or red blood cell losses can be observed, which alert that something is not going well in the functioning of the kidneys. These explorations are completed with an imaging technique such as renal ultrasound and an arterial echo-Doppler to assess the size and arterial flow.

In conclusion, it should be pointed out that the presence of chronic kidney disease, in any of its stages, significantly increases cardiovascular risk. The control of hypertension and other associated risk factors can contribute to the prevention of its onset and development.

In nephrology consultations we are especially aware, not only in the management of arterial hypertension, but also in the overall assessment of cardiovascular risk. This assessment is completed with explorations such as Holter blood pressure, arterial and supra-aortic trunks EchoDoppler by Vascular Surgery, EchoCardiogram and complete blood tests, among others. The objective is to offer the patient individualized treatment and follow-up.