**6. Cardiovascular risk and kidney disease**

The relationship between cardiovascular risk factors and chronic kidney disease is reciprocal: chronic kidney disease is a risk factor for CVD and cardiovascular damage accelerates kidney damage. Therefore, when we talk about vascular damage, we are really also talking about kidney damage and vice versa.

CVD is responsible for the majority of deaths in children with chronic kidney disease because of a high prevalence of traditional and uremia-related cardiovascular risk factors, with the highest risk in patients on dialysis. The cardiovascular alterations begin early in pediatric chronic kidney disease. Early markers of cardiac involvement, such as left ventricular hypertrophy and dysfunction, and early markers of atherosclerosis, such as increased carotid artery intima media thickness and increased arterial stiffness, are frequently present in children with chronic kidney disease [33, 34]. In children with early chronic kidney disease, before needing dialysis, modifiable cardiovascular risk factors should be identified and appropriate interventions should take place to decrease or delay premature CVD. Slowing down the progression of chronic kidney disease with avoidance of dialysis might be the best strategy to decrease cardiovascular risk [35].
