Advanced chronic kidney disease coexisting with heart failure: navigating patients' management

Chronic kidney disease (CKD) and heart failure (HF) are interrelated, mutually exacerbating conditions. HF in patients with moderate to severe CKD poses unique clinical problems. Indeed, considerations related to specific concomitant derangements, such as vascular calcification, inflammation, and proteinuria, inform and demand personalized treatment strategies. Pharmacological interventions, including renin-angiotensin system antagonists, sodium-glucose cotransporter 2 (SGLT2) inhibitors and novel mineralocorticoid receptor blockers are valuable in managing these complex conditions, although frequently difficult or impossible to use in advanced kidney disease. Precision medicine, innovative treatments, and the incorporation of digital health tools, artificial intelligence, remote monitoring, and advanced imaging techniques into patient care are redesigning the scenario of HF associated with CKD. AI-driven predictive analytics for early detection of decompensation, telemedicine for remote consultations, and electronic health records with decision-support systems. These innovations enhance personalized treatment, improve early intervention, and optimize disease management, ultimately leading to better outcomes for patients with HF and CKD. Collaborative care models are being implemented and evaluated to advance the management of such conditions. Thus, the integration of novel therapeutic approaches and personalized medicine holds promise for improving patient outcomes, while ongoing research is essential to enabling innovation in this area. Here we review the current management of concomitant kidney disease and HF, highlighting areas for proposed future refinements.