Controlling the epidemic of cardiovascular disease in chronic renal disease: where do we start?

CARDIOVASCULAR disease (CVD) is the major cause of death in patients with endstage renal disease (ESRD). In the general population, CVD morbidity and mortality have declined substantially over the past three decades through risk factor identification and reduction. In 1997, the National Kidney Foundation (NKF) convened a Task Force, consisting of experts in CVD epidemiology, clinical trials, clinical cardiology, and nephrology, to consider whether strategies for prevention and treatment of CVD in the general population are applicable to patients with chronic renal disease (CRD). This month’s issue of the American Journal of Kidney Diseases contains a summary of the report of the Task Force, including a description of the process used to answer this question, as well as recommendations for clinical practice and clinical research. The recommendations are based on published recommendations for the general population, a systematic review of the nephrology literature, and a consensus of the members of the Task Force. The Task Force report was circulated to a large number of professional organizations and societies for review and after appropriate revisions was approved by the NKF in August 1998. This supplement to the American Journal of Kidney Diseases contains the detailed reports and references on which the summary is based. The supplement is divided into five sections. Section 1 is an introduction by Garabed Eknoyan, MD, President of the National Kidney Foundation (1996-1998). Section 2 is the executive summary, including a statement of the goal of the Task Force, the definition of the target conditions and target populations, principles of CVD risk assessment in the general population, a review of recommendations for treatment in the general population, the Task Force’s synthesis of evidence in CRD, and a summary of the Task Force’s clinical and research recommendations in CRD. Section 3 contains a description of the process used by the Task Force and the bibliography reviewed by the Task Force. Section 4 contains a review of cardiovascular disease epidemiology and interventions in the general population. Section 5 contains a review of risk factors and interventions for CVD in CRD.