Management of Heart Failure in Patients with Chronic Kidney Disease

Abstract

Chronic kidney disease (CKD) is increasingly prevalent in patients with heart failure (HF) and HF is one of the leading causes of hospitalisation, morbidity and mortality in patients with impaired renal function. Currently, there is strong evidence to support the symptomatic and prognostic benefits of β-blockers, renin–angiotensin–aldosterone inhibitors (RAASis), angiotensin receptor-neprilysin inhibitors (ARNIs) and mineralocorticoid receptor antagonists (MRA) in patients with HF and CKD stages 1–3. However, ARNIs, RAASis and MRAs are often suboptimally prescribed for patients with CKD owing to concerns about hyperkalaemia and worsening renal function. There is growing evidence for the use of sodium–glucose co-transporter 2 inhibitors and IV iron therapy in the management of HF in patients with CKD. However, few studies have included patients with CKD stages 4–5 and patients receiving dialysis, limiting the assessment of the safety and efficacy of these therapies in advanced CKD. Interdisciplinary input from HF and renal specialists is required to provide integrated care for the growing number of patients with HF and CKD.

The Factors Influencing Chronic Kidney Disease Incidence: Database from the Korean National Health Insurance Sharing Service (NHISS)

“…The heart and kidneys play important roles in maintaining fluid homeostasis and normal blood pressure. Heart failure progresses and persists with CKD through reduced renal blood flow, renal hemodynamic impairment, and ischemic injury [23,24]. In our study, heart failure increased the risk of CKD only in women (HR 1.24, men 1.06 (no statistical significance), women 1.44).…”

Factors associated with non-fatal heart failure and atrial fibrillation or flutter within the first 30 days post COPD exacerbation: a nested case-control study

“…(35) Diabetes is a risk factor for substantial HF progression (16,36), and separately a population-based study in COPD patients demonstrated an increased risk of cardiovascular mortality with type II diabetes. (37) Impaired renal hemodynamics and activation of the renin-angiotensin-aldosterone system (RAAS) can lead to HF, (38) and separately reduced kidney function is associated with future HF. (39) Our findings for cardiovascular medications indicate a certain treatment profile in primary care, leading up to the post-exacerbation HF hospitalization.…”

The Evolving Role of Vericiguat in Patients With Chronic Heart Failure

“…The aldosterone-stimulated volume retention exacerbates myocardial stretching and increases demands on the already failing heart. In response to myocyte distention, natriuretic peptides are released [ 35 , 38 ]. Additionally, chronic kidney hypoperfusion predisposes patients to CKD and worsens hypertension, diabetic nephropathy, and metabolic derangements, including anemia and uremia, all of which have poor prognostic outcomes [ 26 , 38 ].…”

“…In response to myocyte distention, natriuretic peptides are released [ 35 , 38 ]. Additionally, chronic kidney hypoperfusion predisposes patients to CKD and worsens hypertension, diabetic nephropathy, and metabolic derangements, including anemia and uremia, all of which have poor prognostic outcomes [ 26 , 38 ]. With the United States' growing elderly population and increases in medical advancements, it is believed that by 2030, more than eight million people will be diagnosed with HF [ 39 ].…”