Interconnected pathways and emerging therapies in chronic kidney disease and heart failure: A comprehensive review

Area of Science:

• Nephrology
• Cardiology
• Internal Medicine

Background:

• Chronic kidney disease (CKD) and chronic heart failure (HF) frequently coexist, worsening patient prognosis.
• Common risk factors (diabetes, obesity, hypertension) and pathophysiological mechanisms (inflammation, fibrosis) link CKD and HF.
• Early diagnosis and intervention are crucial for managing comorbid CKD and HF.

Purpose of the Study:

• To review shared therapeutic targets and current management strategies for patients with comorbid CKD and HF.
• To identify challenges and opportunities in optimizing treatment for this patient population.

Main Methods:

• This review synthesizes current evidence on the pathophysiology, risk factors, and treatment of coexisting CKD and HF.
• It examines shared therapeutic targets, including the renin-angiotensin system (RAS), SGLT2 inhibitors, mineralocorticoid receptor (MR) antagonists, and GLP-1 receptor agonists.
• Guideline-recommended treatments for CKD and their application in comorbid HF are discussed.

Main Results:

• Shared pathways and risk factors underscore the interconnectedness of CKD and HF.
• RAS inhibitors, SGLT2 inhibitors, finerenone, and GLP-1 receptor agonists represent key therapeutic targets.
• Polypharmacy due to comorbidities presents a significant management challenge.

Conclusions:

• Optimizing management of comorbid CKD and HF requires addressing shared mechanisms and therapeutic targets.
• Further research and clinical strategies are needed to overcome challenges like polypharmacy and improve outcomes.
• Integrated care approaches focusing on shared targets offer opportunities to enhance patient management.