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.
Highlights
Chronic heart failure (HF) is one of the greatest medical challenges of the 21st century
Chronic kidney disease (CKD) adversely affects many mediators of nitric oxide metabolism (e.g., L-arginine and homocysteine). Another postulated pathological mechanism for pulmonary hypertension is an increase in fibroblast growth factor-23 (FGF-23) concentration, which is observed in the course of CKD
The estimated glomerulus filtration rate (eGFR) has a significant impact on natriuretic peptide concentrations—increases in these peptides result from both damage to the heart and their impaired elimination in the kidneys
Summary
Chronic heart failure (HF) is one of the greatest medical challenges of the 21st century. A sharp increase in mortality is observed when the eGFR value drops below 60 mL/min/1.73 m2, and the highest mortality rates are found among patients with HF and end stage kidney disease, i.e., when the eGFR is
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