Abstract
Congestive heart failure (CHF) and chronic kidney disease (CKD) represent concurrent chronic diseases. The presence of one condition appears to accelerate the presentation and progression of the other[1], having both conditions increase the risk of hospitalization, rehospitalization, need for intensive care or kidney replacement therapy, and death[2]. Intensive volume removal has been the core management to relieve pressure and volume overload in CHF and CKD. However, fluid removal in both concurrent conditions is very challenging. Many strategies have been used, including diuretics, vasopressin V2 receptor antagonist, ultrafiltration, and renal replacement therapy. There are many considerations in patients with advanced heart failure, including diuretic resistance, worsening kidney function, rate of fluid removal, electrolyte abnormalities, and the option of renal replacement therapy[3]. Congestive heart failure (CHF) and chronic kidney disease (CKD) represent concurrent chronic diseases. The presence of one condition appears to accelerate the presentation and progression of the other[1], having both conditions increase the risk of hospitalization, rehospitalization, need for intensive care or kidney replacement therapy, and death[2]. Intensive volume removal has been the core management to relieve pressure and volume overload in CHF and CKD. However, fluid removal in both concurrent conditions is very challenging. Many strategies have been used, including diuretics, vasopressin V2 receptor antagonist, ultrafiltration, and renal replacement therapy. There are many considerations in patients with advanced heart failure, including diuretic resistance, worsening kidney function, rate of fluid removal, electrolyte abnormalities, and the option of renal replacement therapy[3].
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