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Heart failure with reduced ejection fraction and the intersection of cardio-renal-metabolic medicine #CaReMe
Nikolaus Marx1, Alice Y Y Cheng2, Rajiv Agarwal3
1Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße 30, D-52074 Aachen, Germany.
Insights
Heart failure with reduced ejection fraction (HFrEF) management is complicated by diabetes and chronic kidney disease (CKD). This review covers interactions, screening, and treatments, including novel options like Finerenone for these complex patients.
Area of Science:
- Cardiology
- Nephrology
- Endocrinology
Background:
- Diabetes and chronic kidney disease (CKD) are common in heart failure (HF) patients.
- These comorbidities significantly increase morbidity and mortality.
- Advanced CKD limits guideline-directed therapies for heart failure with reduced ejection fraction (HFrEF).
Purpose of the Study:
- To summarize the pathophysiology of HFrEF, CKD, and diabetes interactions.
- To discuss clinical screening for these comorbidities.
- To review current and novel treatment strategies for HFrEF patients with CKD and/or diabetes.
Main Methods:
- Literature review of pathophysiological interactions.
- Analysis of clinical screening approaches.
- Discussion of evidence for current and emerging treatments.
Main Results:
- Patients with HFrEF, diabetes, and CKD present complex management challenges.
- Exclusion of advanced CKD patients in trials necessitates extrapolated treatment recommendations.
- Finerenone emerges as a novel therapeutic strategy.
Conclusions:
- Understanding the interplay of HFrEF, diabetes, and CKD is crucial for effective patient care.
- Screening for these comorbidities is essential for appropriate management.
- Novel agents like Finerenone offer new therapeutic avenues for this patient population.
Abstract:
Diabetes and chronic kidney disease (CKD) are important comorbidities in patients with heart failure (HF) that can complicate the clinical management and have major implications for morbidity and mortality. In addition, the presence of these comorbidities, particularly advanced CKD, is a limitation for the implementation of guideline-directed therapies in patients with HF with reduced ejection fraction (HFrEF). Though clinical trials in patients with HFrEF trials included varying percentages of patients with diabetes and/or CKD, patients with advanced CKD have been excluded in most HF studies. Thus, management recommendations for these patients often have to be extrapolated from subgroup analyses. This article summarizes pathophysiological aspects of the interaction of HFrEF, CKD, and diabetes and addresses clinical aspects for the screening of these comorbidities. Moreover, current treatment options for patients with HFrEF and CKD and/or diabetes are discussed and novel strategies such as the use of the selective mineralocorticoid receptor antagonist Finerenone are addressed.
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