Negotiating renal dysfunction when treating patients with heart failure

ABSTRACT

Introduction: Chronic kidney disease (CKD) is one of the most prevalent comorbidities in HF, and no specific treatment is still available for the so-called cardiorenal syndrome.

Areas covered: The aim of this review is to describe the interaction of heart and kidney function and the consequences of cardiorenal syndrome, focusing on the use of available therapeutics.

Expert commentary: The presence of CKD has been associated with adverse outcomes in HF regardless of ejection fraction. On the other hand, cardiovascular events are the most common causes of morbidity and mortality among CKD patients, reflecting the close pathophysiological crosstalk between these organs. Multiple mechanisms are involved in the development of cardiorenal syndrome, including hemodynamic, neurohormonal and inflammatory mediators. The management of several HF drugs is a challenge in the presence of CKD mainly due to blunted diuretic response and increased risk of worsening of kidney function. Therefore, finding a balance between the optimization of cardiac and renal outcomes is a real negotiation in the everyday clinical practice.

KEYWORDS:

• Heart failure
• renal dysfunction
• chronic kidney disease
• treatment

Declaration of interest

V Carubelli received an unrestricted research grant from CVie Therapeutics Limited and consultancy honoraria from Servier. M Metra has received consulting honoraria from Bayer, Novartis, and Servier. LH Lund, related to the present work; received consulting honoraria from ViforPharma, Relypsa; unrelated to the present work: receives speaker’s or consulting honoraria from St Jude, Novartis, Bayer, AstraZeneca and HeartWare and research grants to author’s institution from Boston Scientific, Medtronic, Novartis and AstraZeneca. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.