Kidney Dysfunction in Heart Failure: Core Curriculum 2025.

The pathophysiology of heart failure (HF) with kidney dysfunction is represented by several maladaptive bidirectional pathways wherein acute or chronic dysfunction of one organ drives acute or chronic dysfunction in the other organ. Suboptimal decongestion, diuretic resistance, and low use rates of guideline-directed medical therapy in individuals with kidney dysfunction and HF contribute to poor cardiovascular and kidney outcomes. Recent developments with the early identification and treatment of diuretic resistance may help mitigate the harmful effects of persistent congestion in individuals with HF. Several classes of guideline-directed medical therapies in HF have been shown to reduce death, hospitalizations for HF, and kidney function decline and improve quality of life. A combination of efficient and personalized strategies to achieve decongestion while optimizing the implementation of evidence-based therapies that modify the trajectory of HF are essential in tandem to reduce adverse outcomes and premature death in this high-risk patient population.