Chronic Kidney Disease and Heart Failure-Everyday Diagnostic Challenges

Area of Science:

• Nephrology
• Cardiology
• Internal Medicine

Background:

• Chronic heart failure (HF) and chronic kidney disease (CKD) are increasing global health concerns.
• Patients with advanced CKD (eGFR <30 mL/min/1.73 m² ) are often excluded from clinical trials, leading to guideline gaps.
• Interdisciplinary collaboration is crucial for addressing complex patient care.

Purpose of the Study:

• To review the challenges in diagnosing HF in patients with advanced CKD.
• To discuss cardiotoxicity associated with dialysis access.
• To examine the incidence of pulmonary hypertension in CKD patients.

Main Methods:

• Literature review conducted by an interdisciplinary team (nephrologist, internists, cardiologist).
• Focus on recent European Society of Cardiology HF guidelines.
• Analysis of existing data on HF diagnosis, dialysis complications, and pulmonary hypertension in CKD.

Main Results:

• Diagnosing HF in advanced CKD is difficult due to overlapping symptoms and exclusion from trials.
• Dialysis fistulas may contribute to cardiotoxicity.
• Pulmonary hypertension is a significant concern in CKD patients.

Conclusions:

• Advanced CKD represents a significant challenge in cardiac care, often termed a "no man's land".
• Clearer guidelines and further research are needed for managing HF and related cardiac issues in CKD patients.
• Addressing these complex issues is vital given the growing CKD population.