Nonatherosclerotic Cardiovascular Disease in Chronic Kidney Disease.

Nonatherosclerotic cardiovascular disease (CVD) in chronic kidney disease (CKD) is highly prevalent and involves distinct pathophysiological mechanisms. Arteriosclerosis, characterized by medial arterial layer thickening and fibrosis, leads to increased arterial stiffness and vascular calcification, driven by disordered bone mineral metabolism. Clinical manifestations of nonatherosclerotic CVD include left ventricular hypertrophy, which occurs in up to 70% to 80% of patients with advanced CKD, heart failure (often with preserved ejection fraction), valvular heart disease, and both fatal and nonfatal arrhythmias. These conditions are exacerbated by CKD-specific factors such as volume overload, anemia, and sympathetic overactivity, contributing to high cardiovascular morbidity and mortality.