Chronic Kidney Disease as a Comorbidity in Heart Failure

Abstract

Heart failure (HF) is one of the greatest problems in healthcare and it often coexists with declining renal function. The pathophysiology between the heart and the kidneys is bidirectional. Common mechanisms leading to the dysfunction of these organs result in a vicious cycle of cardiorenal deterioration. It is also associated with difficulties in the treatment of aggravating HF and chronic kidney disease (CKD) and, as a consequence, recurrent hospitalizations and death. As the worsening of renal function has an undeniably negative impact on the outcomes in patients with HF, searching for new treatment strategies and identification of biomarkers is necessary. This review is focused on the pathomechanisms in chronic kidney disease in patients with HF and therapeutic strategies for co-existing CKD and HF.

Keywords: GFR; angiotensin receptor–neprilysin inhibitor (ARNI); chronic kidney disease (CKD); ejection fraction; finerenone; heart failure (HF); kidney replacement; mineralocorticoid receptor antagonists (MRAs); renin–angiotensin–aldosterone system inhibitors (RAAS-I); sodium–glucose cotransporter 2 inhibitors (SGLT2); uremic toxins.

Figure 1

Relationship between heart failure and chronic kidney disease. RAAS, renin–angiotensin–aldosterone system; SNS, sympathetic nervous system.