Assessment and management of heart failure in patients with chronic kidney disease

Abstract

Heart failure (HF) and chronic kidney disease (CKD) are two pathological conditions with a high prevalence in the general population. When they coexist in the same patient, a strict interplay between them is observed, such that patients affected require a clinical multidisciplinary and personalized management. The diagnosis of HF and CKD relies on signs and symptoms of the patient but several additional tools, such as blood-based biomarkers and imaging techniques, are needed to clarify and discriminate the main characteristics of these diseases. Improved survival due to new recommended drugs in HF has increasingly challenged physicians to manage patients with multiple diseases, especially in case of CKD. However, the safe administration of these drugs in patients with HF and CKD is often challenging. Knowing up to which values ​​of creatinine or renal clearance each drug can be administered is fundamental. With this review we sought to give an insight on this sizable and complex topic, in order to get clearer ideas and a more precise reference about the diagnostic assessment and therapeutic management of HF and CKD.

Keywords: Biomarkers; Cardio-renal syndrome; Chronic kidney disease; Guidelines-directed medical therapy; Heart failure.

Fig. 1

Echocardiographic evaluation of the volume status in heart failure (HF). A case of a patient with HF and fluid overload at the echocardiographic examination, requiring a prompt diuretic treatment. a The bidimensional assessment in the four-chamber view shows a dilated right ventricle, with a severe tricuspid regurgitation and an enlarged right atrium. b The subcostal view displays a marked dilation of the inferior vena cava with a reduced inspiratory collapse. c The continuous wave Doppler on the tricuspid regurgitations may allow an estimation of pressures in the right heart chambers. d Peak systolic velocity on tricuspid annulus by tissue Doppler imaging (S′ wave) represents a useful tool to assess the systolic function of the right ventricle