Management of heart failure in patients with kidney disease-updates from the 2021 ESC guidelines

Area of Science:

• Cardiology
• Nephrology
• Internal Medicine

Background:

• Chronic kidney disease (CKD) and chronic heart failure (HF) frequently overlap.
• CKD contributes to cardiac structural remodeling, leading to HF symptoms in kidney disease patients.
• The 2021 European Society of Cardiology (ESC) guidelines for HF management are crucial for nephrologists.

Purpose of the Study:

• To highlight the importance of the 2021 ESC HF guidelines for nephrologists.
• To outline key changes in the 2021 guidelines compared to the 2016 version.
• To detail updated management strategies for HF, particularly in patients with CKD.

Main Methods:

• Review of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure.
• Comparison of the 2021 guidelines with the previous 2016 iteration.
• Analysis of updated treatment recommendations for HF phenotypes and comorbidities like CKD.

Main Results:

• The 2021 guidelines emphasize identifying three HF phenotypes for tailored management.
• A simplified, sequential four-pillar drug treatment algorithm for HF with reduced ejection fraction is introduced, including SGLT2 inhibitors.
• Device therapy recommendations have been updated, with down-graded indications for ICD and CRT in specific patient groups.

Conclusions:

• Nephrologists must be aware of the 2021 ESC HF guidelines due to the high prevalence of HF in CKD patients.
• Updated guidelines offer a refined approach to HF management, including pharmacotherapy and device therapy.
• Specific attention is given to managing HF in patients with non-cardiovascular comorbidities, such as CKD.