Integrating and Simplifying Evidence to Optimize Cardiorenal Guideline-Directed Therapies

Abstract

Chronic kidney disease (CKD) prevalence is rising worldwide and is projected to become the fifth leading cause of death globally by 2040. The high proportion of undiagnosed early-staged CKD and delayed diagnosis is of significant concern. The access to diagnosis and treatment is also limited in low-resource settings. The majority of individuals with kidney disease succumb to cardiovascular disease complications. Furthermore, heart failure and CKD are closely interconnected, with each condition significantly increasing the risk of developing the other. They share common risk factors, such as high blood pressure and diabetes, and their coexistence worsens prognosis and raises mortality rates. The bidirectional relationship between the heart and kidneys becomes even more complex and challenging in the context of cardiorenal syndrome. Emerging medications, such as sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists, have shown remarkable efficacy in slowing the progression of kidney disease, surpassing the benefits of traditional treatments. This article summarizes the evidence on the early detection of CKD and real-world opportunities to slow the progression of CKD by optimizing cardiorenal guideline-directed medical therapy.

Keywords: cardiorenal outcomes; chronic kidney disease; guideline-directed medical; heart failure.

Figure 1

Methods for assessing glomerular filtration rate (GFR). Adapted with permission from [7].

Figure 2

Staging of chronic kidney disease (CKD). The numbers in the boxes are a guide to the frequency of monitoring (number of times per year). Adapted with permission from reference [7].

Figure 3

Clinical considerations and key monitoring parameters for GDMT for cardiorenal care. Adapted from references [7,27]. Abbreviations: BP = blood pressure, K = potassium, eGFR = estimated glomerular filtration rate, SCr = serum creatinine, uACR = urine albumin-to-creatinine ratio, CBG = capillary blood glucose, CKD = chronic kidney disease, DKA = diabetic ketoacidosis, SGLT2i = sodium–glucose co-transporter 2, GLP-1RA = glucagon-like peptide-1 receptor agonist, RASi = renin-angiotensin system inhibitor, UTI = urinary tract infection.

Figure 4

Proposed effects of GLP-1 receptor agonist. Adapted from reference [70]. Abbreviations: hsCRP = high-sensitivity C-reactive protein.

Figure 5

Four pillars of treatment for chronic kidney disease (CKD). Adapted Adapted with permission from reference [7]. Abbreviations: CKD = chronic kidney disease, CV = cardiovascular, eGFR = estimated glomerular filtration rate, GLP-1RA = glucagon-like peptide-1 receptor agonist, ns-MRA = nonsteroidal mineralocorticoid receptor antagonist, RASi = renin-angiotensin system inhibitor, SGLT2i = sodium–glucose co-transporter 2, T2DM = Type 2 diabetes mellitus, uACR = urine albumin-to-creatinine ratio.