Chronic Kidney Disease and Heart Failure - A Nephrologic Approach

Increasing stages of CKD are associated with increasing incidence and prevalence of congestive heart failure. After adjustment for multiple risk factors, even modest degrees of CKD (and albuminuria) are associated with a significant increase in the adjusted hazard ratio of incident heart failure, underscoring the important relationship between the kidneys and the heart. Evidence supports the hypothesis that CKD, through a variety of proposed mechanisms, contributes to significant functional and structural changes of the heart, culminating in the clinical phenotype recognized as congestive heart failure. Furthermore, CKD and heart disease commonly coexist and may have shared pathophysiology and risk factors. The epidemiological association between CKD and heart failure is robust. Strategies to prevent and treat heart failure in this population are supported somewhat from evidence from RCTs. Improved cardiovascular renal outcomes may result from careful treatment of patients with CKD and heart failure.