The Cardio-Kidney Patient: Epidemiology, Clinical Characteristics and Therapy

Abstract

Patients with chronic kidney disease (CKD) are at high risk to develop cardiovascular disease with its manifestations coronary artery disease, heart failure, arrhythmias, and sudden cardiac death. In addition, the presence of CKD has a major impact on the prognosis of patients with cardiovascular disease, leading to an increased morbidity and mortality if both comorbidities are present. Therapeutic options including medical therapy and interventional treatment are often limited in patients with advanced CKD, and in most cardiovascular outcome trials, patients with advanced CKD have been excluded. Thus, in many patients, treatment strategies for cardiovascular disease need to be extrapolated from trials conducted in patients without CKD. The current article summarizes the epidemiology, clinical presentation, and treatment options for the most prevalent manifestations of cardiovascular disease in CKD and discusses the currently available treatment options to reduce morbidity and mortality in this high-risk population.

The effect of kidney function on guideline‐directed medical therapy implementation and prognosis in heart failure with reduced ejection fraction

“…In a large proportion of landmark randomized controlled trials (RCTs) that assessed different therapeutic options in HFrEF, severely impaired renal function and advanced kidney disease were exclusion criteria, 11–18 so there is a lack of evidence on the safety and efficacy of strategic agents in patient groups with estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m 2 . Thus, the penetration of guideline‐directed medical therapy (GDMT) in HFrEF with concomitant CKD is often low 19–21 . Furthermore, it is a shared concern in everyday practice that the novel recommended parallel implementation of quadruple therapy may amplify the renal side‐effect of all forms of medication, increasing the risk of progressive decline in eGFR even in patients with normal renal function 22 .…”

“…Thus, the penetration of guideline‐directed medical therapy (GDMT) in HFrEF with concomitant CKD is often low. 19 , 20 , 21 Furthermore, it is a shared concern in everyday practice that the novel recommended parallel implementation of quadruple therapy may amplify the renal side‐effect of all forms of medication, increasing the risk of progressive decline in eGFR even in patients with normal renal function. 22 Accordingly, in parallel with the ESC 2021 HF guidelines, the ESC Heart Failure Association published a consensus document focusing on tailored therapy in HFrEF.…”

Practical Approaches to the Management of Cardiorenal Disease Beyond Congestion

“…On the other hand, patients with CVD are prone to develop CKD and acute kidney injury. The co-occurrence of kidney and heart disease results from complex pathophysiological interactions between the two organs, leads to increased morbidity and mortality, and poses diagnostic and therapeutic difficulties [1]. Prognosis of CKD varies according to the categories of glomerular filtration and albuminuria (Fig.…”

Knowledge landscapes and emerging trends of cardiorenal syndrome type 4: a bibliometrics and visual analysis from 2004 to 2022

“…According to the Global Burden of Disease study, there were 697.5 million CKD cases worldwide in 2017, with a prevalence of approximately 9.1% [ 1 ]. Patients with CKD exhibit a great risk for cardiovascular diseases (CVD), and cardiovascular mortality increases with deteriorating kidney function [ 2 ]. At the same time, patients with CVD also have a higher prevalence of concurrent CKD.…”