Traditional vs. nontraditional risk factor assessment in chronic kidney disease: a case for laser Doppler flowmetry?

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Chronic kidney disease (CKD), defined as the presence of kidney damage (≥30 mg/day of urinary albumin excretion) or decreased kidney function [glomerular filtration rate (GFR) <60 ml/min] for at least 3 months, is a major independent risk factor for cardiovascular disease (CVD) [1]. In addition to having a lower GFR and a higher albumin excretion, patients with CKD often have a number of traditional and nontraditional CVD risk factors. Traditional risk factors such as hypertension and diabetes are highly prevalent among patients with CKD [2–4] and have been associated with larger increases in CVD risk at earlier stages of CKD progression [5]. Nontraditional risk factors such as C-reactive protein (CRP), asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA) have been also associated with an increased risk for CVD mortality among patients with CKD [6,7]. Consequently, because the prevalence of these risk factors is high among CKD populations, the risk of CVD mortality is often higher than the risk of progressing to end-stage renal disease (ESRD), making the detection, treatment, and control of CVD risk factors major clinical priorities.

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