9 A Toolkit for Health Care Professionals Screening for Kidney Disease to Reduce CVD Risk These factors contribute to coronary heart disease, cerebrovascular disease, peripheral artery disease (PAD), cardiac arrhythmia and HF. MetS commonly progresses to type 2 diabetes (T2D) due to beta cell dysfunction in the setting of chronic insulin resistance. T2D markedly increases risk for both vascular and kidney disease.4-The current scientific understanding of CKM Syndrome, Fig. 1 The vascular, heart and kidney injuries associated with these processes stem from hemodynamic, metabolic, inflammatory and fibrotic mechanisms. Hyperglycemia induces glomerular hyperfiltration and hypertension, hemodynamic mechanisms long recognized as initiating and propagating kidney damage. Endothelial damage contributes to atherosclerosis and to glomerulosclerosis. Hypertension and obesity underly the development of left ventricular hypertrophy and HF.4-The current scientific understanding of CKM Syndrome Hyperglycemia in T2D promotes kidney and vascular damage through inflammation and fibrosis. Altered glucose metabolism generates advanced glycation end products and reactive oxygen species. Activation of protein kinase C, Janus kinase signaling and other intracellular signaling pathways lead to the ongoing release of proinflammatory mediators, profibrotic factors and immune cell recruitment. These metabolic disturbance pathways may become selfperpetuating despite intensive control of hyperglycemia later in the course of T2D.4-The current scientific understanding of CKM Syndrome CKD, detected or undetected, is a major amplifier of cardiovascular risk. Albuminuria and low glomerular filtration rate (GFR) are both hallmarks of CKD and associated with progressive risk of major atherosclerotic vascular and HF events and with cardiovascular death.4-The current scientific understanding of CKM Syndrome MetS and diabetes predisposes individuals to CKD. 3/4 of kidney failure cases in the United States are attributed to diabetes and hypertension. And while the prevalence of many diabetes complications has fallen in recent years, the number of individuals living with diabetes who develop kidney failure is progressively rising.4-The current scientific understanding of CKM Syndrome CKD, particularly in the presence of diabetes, is a proinflammatory state with elevated markers of systemic inflammation associated with high cardiovascular risk. Vascular calcification is a common complication of CKD and associated with ischemic complications, including myocardial infarction and PAD. CKD + diabetes is more likely to precipitate PAD below the knee, which can be more difficult to treat with revascularization and is linked to greater ischemic injury.4The current scientific understanding of CKM Syndrome CKD can also lead to anemia and bone and mineral disorders, exacerbating CVD.4-The current scientific understanding of CKM Syndrome Conversely, CVD, particularly HF, is associated with the development of CKD. HF may reduce GFR while low eGFR can exacerbate fluid retention and increase vascular congestion in a downward spiral of interlocking organ failure.4-The current scientific understanding of CKM Syndrome CVD, especially HF, can trigger or exacerbate CKD. HF can reduce GFR, and low eGFR can contribute to fluid retention, which can increase vascular congestion, leading to a downward spiral of linked organ failure.4-The current scientific understanding of CKM Syndrome
RkJQdWJsaXNoZXIy MjI2NjI=