Reporting and Definition of Kidney Death in Heart Failure Clinical Trials

Current kidney death definitions across heart failure (HF) trials are ambiguous and lack standardization. The interlinked shared pathways of HF and kidney failure makes it difficult to adjudicate the cause versus effect relationship of worsening HF and kidney failure events and raises concerns whether 'kidney death' is an affirmative or exclusionary diagnosis. Universally standardized definition of kidney death is therefore of utmost importance to accurately ascertain if kidney death is due to kidney failure itself or due to complications associated with it. Conceptually comprehensive and applicable definition(s) would be beneficial for clinicians and investigators in comparing data across trials and for shared decision making. Herein, we review the current definitions of kidney death, the frequency of reporting it across HF trials and the limitations associated with it. Additionally, we propose clinically relevant and comprehensive definitions pertaining kidney organ death which may aid clinicians and researchers alike in accurately distinguishing kidney death from a non-kidney death event.