Why do patients with well-controlled vascular risk factors develop progressive chronic kidney disease?

Abstract Cardiovascular disease and chronic kidney disease (CKD) share several common risk factors, and CKD itself is an independent and graded risk factor of cardiovascular disease. While control of vascular risk factors is associated with improved kidney outcomes, certain patients still demonstrate CKD progression, highlighting that examination of other factors is warranted. This review will explore how blood pressure and glycemic targets appear to differ for macro- vs microvascular disease. Furthermore, factors such as obstructive sleep apnea and obesity are associated with CKD progression. There is increasing recognition of the how sex, gender, ethnicity and socioeconomic position all factor into CKD progression. Uncertainty exists as to what is the optimal diet to prevent loss of kidney function. Lastly, complications of CKD may directly or indirectly contribute to progression of kidney disease. In conclusion, control of vascular risk factors reduces the risk of CKD progression, and careful consideration of these additional factors may ultimately result in improved cardiovascular and CKD outcomes.