● The risk of cardiovascular disease (CVD) in patients with chronic renal disease (CRD) appears to be far greater than in the general population. For example, among patients treated by hemodialysis (HD) or peritoneal dialysis (PD), the prevalence of coronary artery disease (CAD) is approximately 40% and the prevalence of left ventricular hypertrophy (LVH) is approximately 75%. Among HD and PD patients, total deaths caused by CVD in 1995 were approximately 16,000. CVD mortality in HD and PD patients has been estimated to be approximately 9% per year. Even after stratification by age, gender, race, and presence of diabetes, CVD mortality in HD and PD patients is 10 to 20 times higher than in the general population.● Patients with CRD should be considered in the highest risk group for subsequent CVD events. Treatment recommendations based on CVD risk stratification should take into account this ‘‘highest risk’’status of patients with CRD.● Congestive heart failure (CHF) is more common in CRD than in the general population and is an independent predictor of death in CRD. Among HD and PD patients, the prevalence of CHF is approximately 40%. Both CAD and LVH are risk factors for the development of CHF.● In practice, it is difficult to determine whether CHF reflects left ventricular (LV) dysfunction or extracellular fluid (ECF) volume overload. Patients who develop clinical manifestations of CHF should be evaluated for CVD.

● The excess risk of CVD in CRD is caused, in part, by a higher prevalence in these patients of conditions that are recognized as risk factors for CVD in the general population. The predominant factors include older age, hypertension, hyperlipidemia, diabetes, and physical inactivity.● In addition, the excess risk may also be due, in part, to hemodynamic and metabolic factors characteristic of CRD, including proteinuria, increased ECF volume, electrolyte imbalance, anemia, and higher levels of thrombogenic factors and homocysteine than in the general population. Whether other factors unique to CRD also contribute to the excess risk is unknown.