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Cardiorenal syndrome type 4 (CRS type 4), or chronic renocardiac syndrome, has been defined as “chronic abnormalities in renal function leading to cardiac disease” and recognizes the extreme burden of cardiovascular disease (CVD) risk in patients with chronic kidney disease (CKD). CKD is common and increasingly recognized as a risk factor for CVD. Even though the treatment for CVD has dramatically improved over the past decades, it still takes responsibility for up to 50% of deaths in CKD patients. For this reason, patients with CKD should be thoroughly evaluated for cardiovascular risk factors that require careful management, given the significant burden of CRS type 4 on the healthcare system. This review focuses on the most significant conventional and non-conventional CVD risk factors related to CKD. [ABSTRACT FROM AUTHOR]

Abstract: Background: The aim of the present study was to appraise the comparative ability of different ACEF models incorporating glomerular filtration rate or creatinine clearance estimated by the Modification of Diet in Renal Disease [ACEFMDRD] or Cokcroft-Gault [ACEFCG] equations, respectively, over the original ACEF score (ACEFSrCr) in patients undergoing percutaneous coronary intervention (PCI). Methods: A total of 537 patients were analyzed by different measures of discrimination, calibration and net reclassification improvement (NRI). Results: A significant gradient in all-cause mortality was consistently seen with all the models at 30days, 1year and 5years. The comparison of the three models showed that the best balance in terms of discrimination and calibration for all-cause mortality was offered by the ACEFCG at 30days, the ACEFMDRD at 1year and similarly by the ACEFCG and ACEFMDRD at 5years. At 30days, the NRI was +32.9% for ACEFMDRD over ACEFSrCr and +16% for ACEFCG over ACEFSrCr. At 1year, the NRI was 13.8% for ACEFMDRD over ACEFSrCr and −7.8% for ACEFCG over ACEFSrCr. At 5years, the NRI was +7.7% for both the ACEFMDRD and the ACEFCG over the ACEFSrCr. Conclusions: In patients undergoing PCI, the ACEF score is associated with satisfactory early-, mid- and long-term discrimination regardless of the definition of renal function. However, incorporating glomerular filtration rate or creatinine clearance by the MDRD or CG formulas in the ACEF score yields superior calibration compared with the original SrCr-based equation, with the ACEFMDRD displaying superior reclassification ability over the ACEFCG and ACEFSrCr at 30days and 1year. [Copyright &y& Elsevier]