Kidney Disease and Heart Failure: Recent Advances and Current Challenges: Conclusions From a Kidney Disease:...

Area of Science:

• Cardiology
• Nephrology
• Translational Medicine

Background:

• Heart failure (HF) and chronic kidney disease (CKD) frequently coexist, increasing risks of hospitalization, disease progression, and mortality.
• Current diagnostic and management strategies for combined HF and CKD face significant challenges despite advances in individual condition treatments.

Purpose of the Study:

• To address recent advances and current challenges in managing patients with coexisting heart failure and chronic kidney disease.
• To discuss the complex, bidirectional relationship between HF and CKD, including shared pathophysiology and biomarker interpretation.

Main Methods:

• The Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference on Kidney Disease and Heart Failure convened experts in March 2024.
• Discussions focused on shared risk factors, overlapping pathophysiology, biomarker interpretation (natriuretic peptides, serum creatinine), and therapeutic strategies.

Main Results:

• Sodium-glucose cotransporter-2 inhibitors, renin-angiotensin-aldosterone system inhibitors, finerenone, and glucagon-like peptide-1 receptor agonists show potential benefits for HF and CKD patients, though evidence in advanced CKD is limited.
• Small, hemodynamically driven declines in kidney function during HF therapy initiation are generally not associated with poor outcomes and do not necessitate treatment discontinuation.
• The need for CKD-specific HF diagnostic thresholds and refined acute kidney injury definitions in HF was emphasized.

Conclusions:

• An integrated management approach for HF and CKD, emphasizing individualization, clinical context, and shared goals, is essential for improving patient care.
• Future clinical trials should incorporate kidney-specific endpoints, symptom burden, and quality of life measures to better evaluate interventions for this patient population.