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Interrelation between heart failure with preserved ejection fraction and renal impairment
Jennifer Ruth Joslin1,2, Eirini Lioudaki1, Emmanuel Androulakis3
1King's Kidney Care, King's College Hospital, SE5 9RS London, UK.
Reviews in Cardiovascular Medicine
|March 1, 2022
Summary
Heart failure with preserved ejection fraction (HFpEF) and chronic kidney disease (CKD) frequently coexist. This review explores their links, clinical impact, and treatment challenges, highlighting SGLT2 inhibitors as a promising option.
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Heart failure with preserved ejection fraction (HFpEF) and chronic kidney disease (CKD) are prevalent global conditions.
- CKD exacerbates HFpEF through mechanisms like inflammation and fibrosis, impacting patient prognosis.
- Dual diagnosis often involves older patients with more severe disease.
Purpose of the Study:
- To review the pathophysiological connections between HFpEF and CKD.
- To discuss the clinical presentation and implications of this dual diagnosis.
- To examine treatment challenges, particularly hyperkalemia, and emerging therapies.
Main Methods:
- Literature review of pathophysiological mechanisms linking HFpEF and CKD.
- Analysis of clinical data regarding co-diagnosis and prognosis.
- Evaluation of current and emerging pharmacological treatments for HFpEF in CKD patients.
Main Results:
- CKD is a significant negative prognostic factor in HFpEF.
- Acute kidney injury is common in decompensated HFpEF, with unclear long-term outcomes.
- Limited treatment options for HFpEF, especially with CKD and hyperkalemia concerns.
Conclusions:
- Understanding the interplay between HFpEF and CKD is crucial for patient management.
- Sodium-glucose cotransporter 2 (SGLT2) inhibitors show promise for both HFpEF and renal outcomes.
- Further research is needed on HFpEF's impact on CKD prognosis and optimal treatment strategies.
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