Abstract
Heart failure with preserved ejection fraction (HFpEF) and chronic kidney disease (CKD) are global diseases of increasing prevalence and are frequent co-diagnoses. The two conditions share common risk factors and CKD contributes to HFpEF development by a variety of mechanisms including systemic inflammation and myocardial fibrosis. HFpEF patients with CKD are generally older and have more advanced disease. CKD is a poor prognostic indicator in HFpEF, while the impact of HFpEF on CKD prognosis is not sufficiently investigated. Acute kidney injury (AKI) is common during admission with acute decompensated HFpEF, but short and long-term outcomes are not clear. Pharmacological treatment options for HFpEF are currently minimal, and even more so limited in the presence of CKD with hyperkalaemia being one of the main concerns encountered in clinical practice. Recent data on the role of sodium-glucose cotransporter 2 (SGLT2) inhibitors in the management of HFpEF are encouraging, especially in light of the abundance of evidence supporting improved renal outcomes. Herein, we review the pathophysiological links between HFpEF and CKD, the clinical picture of dual diagnosis, as well as concerns with regards to renal impairment in the context of HFpEF management.
Highlights
Heart failure with preserved ejection fraction (HFpEF) is increasingly prevalent across the world and comprises around half of all patients with clinical heart failure [1]
In this paper we will review the pathophysiological links between HFpEF and Chronic kidney disease (CKD), prevalence and prognosis of dual diagnosis, evidence for pharmacological treatment options, and practical considerations for management of the co-existing conditions, and briefly review acute kidney injury (AKI) in patients with HFpEF
There is some evidence that increased fibroblast growth factor 23 levels in CKD induce Left ventricular (LV) hypertrophy [29], while enhanced sympathetic activation in CKD can contribute to heart failure [30], with increased neurohormonal activation noted in both CKD and pulmonary hypertension being associated with vascular remodelling and worse outcomes [31]
Summary
Heart failure with preserved ejection fraction (HFpEF) is increasingly prevalent across the world and comprises around half of all patients with clinical heart failure [1]. Chronic kidney disease (CKD) encompasses structural kidney abnormalities or reduced function over at least three months, and is a growing global burden with a global prevalence of 9.1% [3]. Both HFpEF and CKD are increasingly common at older ages, share a number of risk factors for development, and dual diagnosis is common and set to grow. In this paper we will review the pathophysiological links between HFpEF and CKD, prevalence and prognosis of dual diagnosis, evidence for pharmacological treatment options, and practical considerations for management of the co-existing conditions, and briefly review acute kidney injury (AKI) in patients with HFpEF
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
