Interconnected pathways and emerging therapies in chronic kidney disease and heart failure: A comprehensive review

Abstract

Chronic kidney disease (CKD) and chronic heart failure (HF) frequently coexist and, when comorbid, are associated with poorer outcomes. These two diseases have common risk factors, such as diabetes, obesity and hypertension, and common pathophysiological connected mechanisms, including inflammation, endothelial dysfunction, neurohormonal activation and fibrosis. Early diagnosis and intervention are important to slow CKD progression and reduce HF events. Shared therapeutic targets for CKD and HF include the renin–angiotensin system (RAS), sodium-glucose cotransporter 2 (SGLT2), mineralocorticoid receptor (MR) and glucagon-like peptide-1 (GLP-1) receptor. For the management of CKD, current treatment guidelines recommend the use of RAS inhibitors, SGLT2 inhibitors, the nonsteroidal MR antagonist finerenone and GLP-1 receptor agonists. Challenges in the management of patients with CKD and HF include the presence of other comorbidities, leading to polypharmacy. This review highlights gaps and opportunities for improving the management of patients with CKD and chronic HF.