Kidney-Vascular Metabolic Crosstalk: Altered Lipoproteins in CKD

Cardiovascular disease and chronic kidney disease are highly interconnected, with declining kidney function markedly increasing cardiovascular risk. Chronic kidney disease profoundly disrupts lipoprotein metabolism, leading to qualitative and quantitative alterations that modify lipoprotein composition, function, and clearance. These changes influence not only arterial wall cells, promoting vascular inflammation, smooth muscle cell dysfunction, and macrophage inflammation, as well as atherosclerosis, but also renal cell populations, potentially exacerbating kidney injury and accelerating disease progression. In this review, we examine mechanisms by which kidney dysfunction contributes to heightened cardiovascular risk. We place particular emphasis on altered lipoprotein metabolism as a central mediator linking vascular and renal pathology in chronic kidney disease, highlighting how dysfunctional lipoproteins may drive parallel injury responses in both the artery wall and the kidney.