The relative effects of various cardiovascular diseases (CVDs) and  co-morbidity on mortality risk, direct medical cost, and life expectancy in patients with diabetes are unclear. Chronic kidney disease promotes hypertension and dyslipidemia, which in turn can contribute to the progression of renal failure. Furthermore, diabetic nephropathy is the leading cause of renal failure in developed countries. Chronic kidney disease (CKD) is recognized as a health concern globally and leads to high rates of morbidity, mortality and healthcare expenditure. CKD is itself an independent risk factor for unfavorable health outcomes that include cardiovascular disease.

Also subjects with chronic renal failure are exposed to increased morbidity and mortality as a result of cardiovascular events. Prevention and treatment of cardiovascular disease are major considerations in the management of individuals with chronic kidney disease.

It is increasingly apparent that individuals with chronic kidney disease (CKD) are more likely to die of cardiovascular (CV) disease (CVD) Cardiovascular co-morbidity, than to develop kidney failure. Most studies conducted among patients with diabetes have assessed the mortality risk caused by either CVD or CKD alone (10–14). Moreover, the results to date have been inconsistent in that the relative mortality risks have ranged from 1.5 to 3.3 for CVD and from 0.94 to 5.0 for CKD (10–15). It is therefore hard to compare the differences between the burden of the CVD and CKD. The impact of the comorbid CVD and CKD is also unclear

Coronary artery disease is the primary type of CVD in CKD patients and a significant cause of death among renal transplant patients. Traditional and non-traditional risk factors for CVD exist in patients with CKD. Traditional factors include smoking, hypertension, dyslipidemia and diabetes which are highly prevalent in CKD patients. Non-traditional risk factors of CKD are mainly uraemia-specific and increase in prevalence as kidney function declines. Some examples of uraemia-specific risk factors that have been well documented include low levels of haemoglobin, albuminuria, and abnormal bone and mineral metabolism.