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Patients with chronic kidney disease (CKD) exhibit a massively increased risk for cardiovascular events: 50% of patients with CKD stage 4-5 suffer from cardiovascular disease (CVD), and cardiovascular mortality accounts for ~40-50% of all deaths in patients with CKD stage 4 as well as patients with end-stage renal disease, compared with 26% in controls with normal kidney function. In addition to the high risk for fatal atherosclerosis-related complications such as ischemic heart disease and stroke, cardiac deaths also result from heart failure and arrhythmias. In more than 70 studies in non-dialyzed subjects with CKD, correction for classical and even less classical cardiovascular risk factors, such as hypertension, diabetes mellitus and dyslipidemia, did not neutralize the impact of CKD on cardiovascular risk.

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The underlying pathophysiological processes of CVD in CKD patients obviously differ from the CVD processes in the general population. This underlines the importance of non-traditional, CKD-specific cardiovascular risk factors and accentuates that CKD itself is an independent risk factor for cardiovascular events. This may explain at least in part why traditional strategies to improve cardiovascular outcome have largely failed in the context of CKD. This also emphasizes the need to identify pathological mechanisms adversely affecting the cardiovascular system in CKD, with the aim to reduce the increased cardiovascular mortality in CKD patients through novel therapeutic strategies.

The aim of this Transregional Collaborative Research Center TRR219 is to analyze in experimental and clinical studies the multi-factorial aspects of CKD-related cardiovascular morbidity and mortality caused by alterations in the circulation and the myocardium. In addition to examining pathological mechanisms affecting the cardiovascular system in CKD at the basic science level, we will also study the translational aspects by analyzing novel interventions and diagnostic tests in the context of CKD-related cardiovascular pathology.