Diagnosis of cardiovascular disease in patients with chronic kidney disease

Patients with chronic kidney disease (CKD) are at high risk of cardiovascular disease (CVD) and cardiovascular death. Identifying and monitoring cardiovascular complications and hypertension is important for managing patients with CKD or kidney failure and transplant recipients. Biomarkers of myocardial ischaemia, such as troponins and electrocardiography (ECG), have limited utility for diagnosing cardiac ischaemia in patients with advanced CKD. Dobutamine stress echocardiography, myocardial perfusion scintigraphy and dipyridamole stress testing can be used to detect coronary disease in these patients. Left ventricular hypertrophy and left ventricular dysfunction can be detected and monitored using various techniques with differing complexity and cost, including ECG, echocardiography, nuclear magnetic resonance, CT and myocardial scintigraphy. Atrial fibrillation and other major arrhythmias are common in all stages of CKD, and ambulatory heart rhythm monitoring enables precise time profiling of these disorders. Screening for cerebrovascular disease is only indicated in asymptomatic patients with autosomal dominant polycystic kidney disease. Standardized blood pressure is recommended for hypertension diagnosis and treatment monitoring and can be complemented by ambulatory blood pressure monitoring. Judicious use of these diagnostic techniques may assist clinicians in detecting the whole range of cardiovascular alterations in patients with CKD and enable timely treatment of CVD in this high-risk population. Here, the authors review techniques for cardiovascular diagnosis, screening and monitoring in patients with CKD, including approaches to the diagnosis of cardiac ischaemia, left ventricular hypertrophy and dysfunction, arrhythmia, cerebrovascular disease, peripheral arterial disease, arterial stiffness and hypertension. Cardiovascular disease is the main comorbidity of chronic kidney disease (CKD), and most patients with CKD die from cardiovascular causes before they progress to kidney failure; detection of anatomical and functional cardiovascular abnormalities and hypertension is important to enable management of these complications.Dobutamine stress echocardiography, myocardial perfusion scintigraphy, dipyridamole stress testing and CT angiography are valid methods for detecting coronary disease in patients with CKD or kidney failure.Left ventricular hypertrophy and left ventricular dysfunction can be detected and monitored using various techniques with differing cost and complexity, including electrocardiography, echocardiography and nuclear magnetic resonance.Major arrhythmias are common in patients with CKD and kidney failure; ambulatory heart rhythm monitoring enables precise time profiling of these disorders.Screening for cerebrovascular disease is only indicated in asymptomatic patients with autosomal dominant polycystic kidney disease.Standardized blood pressure measurements and ambulatory blood pressure monitoring are recommended for diagnosis and monitoring of hypertension in patients with CKD or kidney failure.