The importance of chronic kidney disease in the management of patients with heart failure

Abstract

Chronic kidney disease (CKD) is one of the main limiting factors in the application of guideline-directed medical therapy (GDMT) in heart failure (HF). Paradoxically, the patients – suffering from these two diseases with high mortality rates – are the least likely to receive optimal, prognosis-modifying drug therapy. Based on the results of the randomised controlled trials published in recent years, the angiotensin receptor-neprilysin inhibitor (ARNI) and sodium-glucose cotransporter 2 inhibitor (SGLT2i) dapa- and empagliflozin became the fourth pillar of the foundational, first-line therapy of HF with reduced ejection fraction (HFrEF) in the international HF guidelines and consensus documents; which have been shown to have a beneficial effect not only on the prognosis of HF but also on the course of CKD. In addition, we already have strategic morbidity- and mortality-reducing agents as dapa- and empagliflozin in both HF with mildly reduced ejection fraction (HFmrEF) and HF with preserved ejection fraction (HFpEF), which can favourably modify both the prognosis of HF and CKD. The present manuscript summarizes the relationship between CKD and HF and their impact on GDMT optimisation, focusing on the implementation of SGLT2is in daily clinical practice.

Keywords

• heart failure
• chronic kidney disease
• pharmacotherapy