Obesity in Cardiorenal syndrome: Management Opportunities and Challenges

The prevalence of obesity continues to increase globally. There is accumulating evidence of the complex interplay between obesity, cardiovascular disease, particularly heart failure with preserved ejection fraction, and chronic kidney disease (CKD). Here, we review the diagnostic and management considerations for these co-existent conditions and the current evidence regarding the impact of obesity treatments on long term health outcomes.

Recent evidence suggests the pathophysiology of obesity, heart failure with preserved ejection fraction and CKD are inextricably linked as adipocytes appear to play a role in promoting renal sodium avidity and volume overload, which are the hallmarks of the cardiorenal syndrome. The clinical landscape of obesity management has changed significantly with the approval of glucagon-like peptide-1 receptor agonists, which have been shown to have cardiovascular and kidney benefit among patients with obesity and a range of comorbid conditions including diabetes, CKD, and heart failure. Improved recognition, diagnosis and management of clinically consequential obesity is emerging as a key factor in improving outcomes for patients with comorbid conditions such as heart failure with preserved ejection fraction and CKD. The incorporation of comprehensive multi-disciplinary management, shared decision making with patients and broader access to therapies is critical to improving clinical outcomes.