The Intersection of Heart Failure with Preserved Ejection Fraction and Chronic Kidney Disease

Area of Science:

• Nephrology
• Cardiology
• Internal Medicine

Background:

• Heart failure with preserved ejection fraction (HFpEF) and chronic kidney disease (CKD) frequently coexist.
• CKD significantly increases HFpEF risk due to specific pathophysiological pathways beyond traditional risk factors.
• HFpEF heterogeneity poses challenges in diagnosis, treatment, and prevention.

Purpose of the Study:

• To review the epidemiology of HFpEF in CKD patients.
• To explore CKD-specific pathways contributing to HFpEF development.
• To examine the influence of CKD on HFpEF phenotyping and propose a prevention strategy.

Main Methods:

• Literature review focusing on HFpEF and CKD.
• Analysis of pathophysiological mechanisms linking CKD and HFpEF.
• Discussion of phenotyping approaches for HFpEF in CKD.
• Development of a risk-based prevention algorithm.

Main Results:

• CKD is a major contributor to HFpEF development and mortality.
• CKD-specific factors significantly impact HFpEF pathophysiology and presentation.
• Phenotyping is crucial for personalized HFpEF management in CKD.
• A risk-based algorithm can guide HFpEF prevention in CKD.

Conclusions:

• CKD profoundly influences HFpEF epidemiology, development, and phenotyping.
• Targeted phenotyping and risk stratification are essential for managing HFpEF in CKD.
• A proposed prevention algorithm may improve outcomes for CKD patients at risk for HFpEF.