Cardiorenal continuum: A proposal for the prevention of cardiovascular and renal disease
PDF (Español (España))
HTML (Español (España))


Cardiorenal continuum, cardiovascular disease, chronic kidney disease, albuminuria, risk factors, hypertension, dyslipidemia, diabetes.

How to Cite

Amair M P, Arocha Rodulfo I. Cardiorenal continuum: A proposal for the prevention of cardiovascular and renal disease. Rev. Colomb. Nefrol. [Internet]. 2020 Jan. 7 [cited 2021 Dec. 7];7(1). Available from:


Cardiovascular risk factors such as arterial hypertension, type 2 diabetes mellitus (DM2) and dyslipidemia are commonly involved with chronic kidney disease (CKD) and its contribution to long-term cardiovascular morbidity. Diffuse endothelial dysfunction and atherosclerosis are believed to be part of the common pathophysiology in diabetic and non-diabetic CKD, particularly in the elderly. Age is the main determinant of glomerular filtration rate (GFR) and effective renal plasma flow and has been reported that the presence of hypertension at baseline enhances the yearly decline in creatinine clearance. Dyslipidemia may directly affect the kidney by causing deleterious renal lipid disturbances (renal lipotoxicity), as well as indirectly through systemic inflammation and oxidative stress, vascular injury, hormones change and other signaling molecules with renal action. Several cross-sectional studies found that impaired glucose tolerance, as well as the presence of left ventricular hypertrophy, was associated with an increase in the slope of the inverse relationship between age and GFR in subjects with never-treated essential hypertension. Most of the drugs used to reduce the burden of risk factor on cardiovascular disease also benefit the renal function. So, we propose the cardiorenal continuum as a preventive strategy to protect both organ and reduce the deleterious impact of the cardiovascular risk factor on the renal function considering both organs as a functional and physiopathological binomial.
PDF (Español (España))
HTML (Español (España))


Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment. Lancet Diabetes Endocrinol. 2014;2(8):634-47. Available from:

Amsalem Y, Garty M, Schwartz R, Sandach A, Behar S, Caspi A, et al. Prevalence and significance of unrecognized renal insufficiency in patients with heart failure. Eur Heart J. 2008;29(8):1029-36. Available from:

Ronco C, House AA, Haapio M. Cardiorenal syndrome: refining the definition of a complex symbiosis gone wrong. Intensive Care Med. 2008;34(5):957-62. Available from:

Arocha JI, Amair P. El eje cardiorrenal: una nueva estrategia con trascendencia clínica. Av. Cardiol. 2010;30(4):382-7.

Guyton AC. The surprising kidney-fluid mechanism for pressure control-its infinite gain! Hypertension. 1990;16(6):725-30. Available from:

Stevenson LW, Nohria A, Mielniczuk L. Torrent or torment from the tubules? Challenge of the cardiorenal connections. J Am Coll Cardiol. 2005;45(12):2004-7. Available from:

Bakris G, Vassalotti J, Ritz E, Wanner C, Stergiou G, Molitch M, et al. National Kidney Foundation consensus conference on cardiovascular and kidney diseases and diabetes risk: an integrated therapeutic approach to reduce events. Kidney Int. 2010;78(8):726-36. Available from:

Gracia M, Betriu À, Martínez-Alonso M, Arroyo D, Abajo M, Fernández E, et al. Predictors of Subclinical Atheromatosis Progression over 2 Years in Patients with Different Stages of CKD. Clin J Am Soc Nephrol. 2016;11(2):287-96. Available from:

Hsu S, Rifkin DE, Criqui MH, Suder NC, Garimella P, Ginsberg C, et al. Relationship of femoral artery ultrasound measures of atherosclerosis with chronic kidney disease. J Vasc Surg. 2018;67(6):1855-63.e1. Available from:

Kastarinen H, Ukkola O, Kesäniemi YA. Glomerular filtration rate is related to carotid intima-media thickness in middle-aged adults. Nephrol Dial Transplant. 2009;24(9):2767-72. Available from:

Buscemi S, Geraci G, Massenti FM, Buscemi C, Costa F, D’Orio C, et al. Renal function and carotid atherosclerosis in adults with no known kidney disease. Nutr Metab Cardiovasc Dis. 2017;27(3):267-73. Available from:

Botdorf J, Chaudhary K, Whaley-Connell A. Hypertension in Cardiovascular and Kidney Disease. Cardiorenal Med. 2011;1(3):183-92. Available from:

Doshi SM, Friedman AN. Diagnosis and Management of Type 2 Diabetic Kidney Disease. Clin J Am Soc Nephrol. 2017;12(8):1366-73. Available from: CJN.11111016

Bulbul MC, Dagel T, Afsar B, Ulusu NN, Kuwabara M, Covic A, et al. Disorders of Lipid Metabolism in Chronic Kidney Disease. Blood Purif. 2018;46(2):144-52. Available from:

Orth SR. Effects of Smoking on Systemic and Intrarenal Hemodynamics: Influence on Renal Function. J Am Soc Nephrol. 2004;15(Suppl 1):S58-63. Available from:

Bramlage P, Lanzinger S, van Mark G, Hess E, Fahrner S, Heyer CHJ, et al. Patient and disease characteristics of type-2 diabe- tes patients with or without chronic kidney disease: an analysis of the German DPV and DIVE databases. Cardiovasc Diabetol. 2019;18(1):33. Available from:

Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA AAPA/ABC/ ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):1269-324. Available from: HYP.0000000000000066

William B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-104. Available from:

Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015; 373(22):2103-16. Available from: NEJMoa1511939.

Bragg F, Li L, Bennett D, Guo Y, Lewington S, Bian Z, et al. Association of Random Plasma Glucose Levels With the Risk for Cardiovascular Disease Among Chinese Adults Without Known Diabetes. JAMA Cardiol. 2016;1(7):813-23. Available from:

American Diabetes Association. 11. Microvascular compli- cations and foot care: Standards of Medical Care in Diabetes 2019. Diabetes Care. 2019;42(Suppl 1):S124-38. Available from:

Bancks MP, Ning H, Allen NB, Bertoni AG, Carnethon MR, Correa A, et al. Long-Term Absolute Risk for Cardiovascular Disease Stratified by Fasting Glucose Level. Diabetes Care. 2019;42(3):457-65. Available from:

Pascual V, Serrano A, Pedro-Botet J, Ascaso J, Barrios V, Millán J, et al. Enfermedad renal crónica y dislipidemia. Clin Investig Arterioscler. 2017;29(1):22-35. Available from:

Wanner C, Tonelli M; Kidney Disease: Improving Global Outcomes Lipid Guideline Development Work Group Members. KDIGO Clinical Practice Guideline for Lipid Management in CKD: summary of recommendation statements and clinical approach to the patient. Kidney Int. 2014;85(6):1303-9. Available from:

Waters DD. LDL-cholesterol lowering and renal outcomes. Curr Opin Lipidol. 2015;26(3):195-9. Available from:

McMahon GM, Preis SR, Hwang SJ, Fox CS. Mid-adulthood risk factor profiles for CKD. J Am Soc Nephrol. 2014;25(11): 2633-41. Available from:

Chang AR, Grams ME, Ballew SH, Bilo H, Correa A, Evans M. et al. Adiposity and risk of decline in glomerular filtration rate: meta-analysis of individual participant data in a global consortium. BMJ. 2019;364:k5301. Available from:

Sikorska D, Grzymislawska M, Roszak M, Gulbicka P, Korybalska K, Witowski J. Simple obesity and renal function. J Physiol Pharmacol. 2017;68(2):175-80.

Escasany E, Izquierdo-Lahuerta A, Medina-Gomez G. Underlying Mechanisms of Renal Lipotoxicity in Obesity. Nephron. 2019;143(1):28-32. Available from:

Kovesdy CP, Furth S, Zoccali C; en nombre del Comité Directivo del Día Mundial del Riñón. Electronic address: myriam@ Obesidad y enfermedad renal: consecuencias ocultas de la epidemia. Nefrologia. 2017;37(4): 360-9. Available from: 02.005.

Nam KH, Yun HR, Joo YS, Kim J, Lee S, Lee C, et al. Changes in obese metabolic phenotypes over time and risk of incident chronic kidney disease. Diabetes Obes Metab. 2018;20(12): 2778-91. Available from:

Chang AR, Surapaneni A, Kirchner HL, Young A, Kramer HJ, Carey DJ, et al. Metabolically Healthy Obesity and Risk of Kidney Function Decline. Obesity (Silver Spring). 2018;26(4): 762-8. Available from:

Kuller LH, Ockene JK, Meilahn E, Wentworth DN, Svendsen KH, Neaton JD. Cigarette smoking and mortality. MRFIT Research Group. Prev Med. 1991;20(5):638-54. Available from:

Rezonzew G, Chumley P, Feng W, Hua P, Siegal GP, Jaimes EA. Nicotine exposure and the progression of chronic kidney disease: role of the α7-nicotinic acetylcholine receptor. Am J Physiol Renal Physiol. 2012;303(2):F304-12. Available from:

Lan X, Lederman R, Eng JM, Shoshtari SS, Saleem MA, Malhotra A, et al. Nicotine Induces Podocyte Apoptosis through Increasing Oxidative Stress. PLoS One. 2016;11(12):e0167071. Available from:

Kim CS, Choi JS, Joo SY, Bae EH, Ma SK, Lee J, et al. Nicotine- Induced Apoptosis in Human Renal Proximal Tubular Epithelial Cells. PLoS One. 2016;11(3):e0152591. Available from:

Jaimes EA, Tian RX, Raij L. Nicotine: the link between cigarette smoking and the progression of renal injury? Am J Physiol Heart Circ Physiol. 2007;292(1):H76-82. Available from:

López-Jaramillo P, Sánchez RA, Diaz M, Cobos L, Bryce A, Parra Carrillo JZ, et al. Latin American consensus on hypertension in patients with diabetes type 2 and metabolic syndrome. J Hypertens. 2013;31(2):223-38. Available from:

Jha V, García-García G, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: global dimension and perspectives. Lancet. 2013;382(9888):260-72. Available from:

Ruilope LM, Salvetti A, Jamerson K, Hansson L, Warnold I, Wedel H, et al. Renal function and intensive lowering of blood pressure in hypertensive participants of the hypertension optimal treatment (HOT) study. J Am Soc Nephrol. 2001;12(2):218-25.

Mann JF, Gerstein HC, Yi QL, Franke J, Lonn EM, Hoogwerf BJ, et al. Progression of renal insufficiency in type 2 diabetes with and without microalbuminuria: results of the Heart Outcomes and Prevention Evaluation (HOPE) randomized study. Am J Kidney Dis. 2003;42(5):936-42. Available from:

Matsushita K, Ballew SH, Coresh J. Cardiovascular risk prediction in people with chronic kidney disease. Curr Opin Nephrol Hypertens. 2016;25(6):518-23. Available from:

Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Eng J Med. 2004;351(13):1296-305. Available from:

Keith DS, Nichols GA, Gullion CM, Brown JB, Smith DH. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med. 2004;164(6):659-63. Available from:

Cerasola G, Mulè G, Nardi E, Cusimano P, Palermo A, Arsena R, et al. Clinical correlates of renal dysfunction in hypertensive patients without cardiovascular complications: the REDHY study. J Hum Hypertens. 2010;24(1):44-50. Available from:

Hemmelgarn BR, Manns BJ, Lloyd A, James MT, Klarenbach S, Quinn RR, et al. Relation between kidney function, proteinuria, and adverse outcomes. JAMA. 2010;303(5):423-9. Available from:

Sabio R, Valdez P, Turbay YA, Andrade-Belgeri RE, Oze-de Morvil GAA, Arias C, et al. Recomendaciones latinoamerica- nas para el manejo de la hipertensión arterial en adultos (RELAHTA 2). Rev virtual Soc Parag Med Int. 2019;6(1):86-123. Available from:

Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. Guía ESC 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica. Rev Esp Cardiol. 2016;69(10):939.e1-e87. Available from:

Major RW, Cheung CK, Gray LJ, Brunskill NJ. Statins and Cardiovascular Primary Prevention in CKD: A Meta-Analysis. Clin J Am Soc Nephrol. 2015;10(5):732-9. Available from:

Xie X, Atkins E, Lv J, Bennett A, Neal B, Ninomiya T, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta- analysis. Lancet. 2016;387(10017):435-43. Available from:

Muskiet MHA, Tonneijck L, Smits MM, Kramer MH, Heerspink HJ, van Raalte DH. Pleiotropic effects of type 2 diabetes management strategies on renal risk factors. Lancet Diabetes Endocrinol. 2015;3(5):367-81. Available from:

No national or foreign publication may partially or totally reproduce or translate Revista Colombiana de Nefrología articles or abstracts without prior written permission from the journal’s Editorial Board.


Download data is not yet available.