Heart failure in patients with chronic kidney disease

Heart failure is highly prevalent in the population with chronic kidney disease. Upon starting dialysis, 37% of patients will have had a previous episode of heart failure, doubling the risk of death. Both systolic and/or diastolic function may be impaired. 15% of patients starting dialysis therapy have systolic dysfunction of the left ventricle. The prevalence of diastolic dysfunction at dialysis inception is unknown, but is likely to be high. Either systolic or diastolic dysfunction can lead to clinically evident congestive heart failure. Hypertension and coronary heart disease are important causes of myocardial dysfunction in end-stage renal disease. Individuals with chronic kidney disease are at a very high risk for the development and progression of cardiovascular disease. The increased risk of cardiovascular disease is due to a higher prevalence of both traditional risk factors as well as nontraditional "uremia-related" risk factors. The prevalence of coronary artery disease (CAD) approaches 40% among patients starting dialysis. About 70-80% of these patients have hypertension. Anaemia is a known risk factor for left ventricular hypertrophy (LVH) and dilatation, heart failure and death. The diagnosis and treatment of heart failure in the patients with chronic kidney disease (CKD) are similar to that recommended for patients without CKD. The potent drugs like ACE-I, AT-1 antagonists, beta-receptor antagonists are the main tools in nowadays treatment of CHF. New therapeutic regiments using natriuretic peptides are being evaluated in clinical settings.