Managing chronic kidney disease, diabetes and coronary artery disease

Chronic kidney disease (CKD) is a major public health problem because of its rising prevalence internationally (Yang et al, 2020). Much of this increase in prevalence, especially in high income countries, is associated with CKD that develops as a result of diabetes mellitus (DM) and/or hypertension (HT), both of which are linked to sedentary lifestyles and sub-optimal diets (Winocour, 2018; Pugh et al, 2019).

Not only are DM and HT risk factors for the development of CKD but they also contribute to the development of cardiovascular disease (CVD), including coronary artery disease (CAD), both in people living with CKD and those without (Naito and Miyauchi, 2017; National Institute for Health and Care Excellence (NICE), 2022a). As well as the excess risk of CAD from these well-known risk factors, people living with CKD experience a heightened risk of CAD arising from uraemia (including inflammation), an altered calcium-phosphate metabolism and oxidative stress (Sarnak et al, 2019). This risk dramatically increases as the individual’s kidney function declines (Sarnak et al, 2019), putting people living with CKD and diabetes in an especially high-risk group for all forms of CVD, including CAD.