Chronic Kidney Disease and Heart Failure–Everyday Diagnostic Challenges

Abstract

Is advanced chronic kidney disease (CKD) a cardiac “no man’s land”? Chronic heart failure (HF) is widely believed to be one of the most serious medical challenges of the 21st century. Moreover, the number of patients with CKD is increasing. To date, patients with estimated glomerular filtration rates <30 mL/min/1.73 m2 have frequently been excluded from large, randomized clinical trials. Although this situation is slowly changing, in everyday practice we continue to struggle with problems that are not clearly addressed in the guidelines. This literature review was conducted by an interdisciplinary group, which comprised a nephrologist, internal medicine specialists, and cardiologist. In this review, we discuss the difficulties in ruling out HF for patients with advanced CKD and issues regarding the cardiotoxicity of dialysis fistulas and the occurrence of pulmonary hypertension in patients with CKD. Due to the recent publication of the new HF guidelines by the European Society of Cardiology, this is a good time to address these difficult issues. Contrary to appearances, these are not niche issues, but problems that affect many patients.

Endothelin type A receptor blockade increases renoprotection in congestive heart failure combined with chronic kidney disease: Studies in 5/6 nephrectomized rats with aorto-caval fistula

“…First, our data support the evidence that in the advanced stage of CKD as well as CHF organ-protection afforded by RAS blockade is far from complete [3,4,6,8,9,15,28,29,49], especially when both diseases are combined. Second, our present findings emphasize the difference between organ-protective effects of treatment regimens when initiated immediately after the onset of the damaging insult, and when some degree of CKD and CHF has already beenestablished.…”

“…The incidence and prevalence of chronic kidney disease (CKD) is also increasing [3] and CKD is one of the strongest risk factors for the development of CHF [4,5]. CHF coexists with CKD in approximately half of CHF patients [4][5][6][7][8]. Unfortunately, patients with estimated glomerular filtration rate ≤ 30 ml/min/1.73 m 2 have now largely been excluded from randomized control trials in HF, which limits the information on patients with combined CHF and CKD [4,5,7,8].…”

Soluble (Pro)Renin Receptor Levels Are Regulated by Plasma Renin Activity and Correlated with Edema in Mice and Humans with HFrEF

“…Chronic renal dysfunction (eGFR ≤ 60 mL/min/1.73 m 2 ) accelerates HFrEF decompensation and mortality [ 43 , 44 , 45 ]. In patients with sHF with rEF, the elevation of circulating s(P)RR levels was associated with renal dysfunction [ 31 , 32 , 33 ].…”

Association of Hyperuricemia with Impaired Left Ventricular Systolic Function in Patients with Atrial Fibrillation and Preserved Kidney Function: Analysis of the POL-AF Registry Cohort

“…According to a meta-analysis by Damman et al, CKD was found in approximately half of patients with HF. Other studies have indicated that kidney damage occurred in 43% of patients with chronic HF and in 53% of patients with acute HF [ 19 , 20 , 21 ]. Many studies have also shown that AF increased the risk of CKD, and vice versa [ 22 , 23 ].…”