Renal disease: a common and a silent killer.

Cardiovascular risk profiling and therapy have traditionally been based on established risk factors, such as age, smoking, sex, hypertension, dyslipidemia, body weight, and diabetes mellitus. Despite optimum therapy, cardiovascular mortality and morbidity remain high. Attention is being devoted, therefore, to identifying new risk factors that can also be used as therapeutic targets. Renal dysfunction manifesting as low glomerular filtration rate, albuminuria, or anemia is a strong risk factor for cardiovascular disease and is prevalent in the general population and among patients with cardiovascular disease. Epidemiological data suggest that 10-11% of the general population have low glomerular filtration rates, 5-7% have increased urinary albumin excretion, and 5-10% have anemia. Each of these features represents an independent but additive cardiovascular risk. Treatments for all these indications can reduce cardiovascular mortality and morbidity as well as renal risk. Such findings suggest that treatment should be directed towards improving renal function in order to achieve optimum cardiovascular benefit. Such a strategy would offer the possibility of multiorgan therapy in diseases characterized by multiorgan impairment, such as type 2 diabetes. I present the evidence that renal dysfunction is a common and powerful cardiovascular risk factor and that treatment strategies intervening in the renin-angiotensin-aldosterone system can be used to target albuminuria and reduce cardiovascular and renal risk.