Managing Heart Failure in Chronic Kidney Disease: A Review of Current Literature

The purpose of this review was to discuss recent literature pertaining to the management of heart failure (HF) in patients with chronic kidney disease (CKD).

Guideline-directed medical therapy (GMT) is now recommended for treatment of HF. Many of these therapies have great promise in patients with CKD with or at risk of HF, to improve both cardiovascular and kidney outcomes. Current evidence supports the use of renin angiotensin aldosterone system (RAAS) inhibitors (with or without dual neprilysin inhibition), mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter 2 (SGLT-2) inhibitors to treat HF in CKD. An emerging and noteworthy class of medications are the glucagon-like peptide 1 (GLP1) agonists, which are currently being investigated as additional therapeutic agents in this population. Given available data, it may be reasonable to consider loop diuretics and oral potassium binders to manage hyperkalemia and allow continuation of GDMT. The role of dietary interventions, including low-sodium diets, are less well-established with recent literature. Despite these advances, there remain key barriers in the application of GDMT in CKD patients; namely, more data is needed on efficacy and safety across the spectrum of CKD, and greater strides need to be made towards addressing challenges in implementation.

Current data supports the use of GDMT in patients with HF, which includes RAAS inhibition (with or without neprilysin inhibition), mineralocorticoid receptor antagonism, and SGLT-2 inhibitors. These therapies also have promise in patients with CKD to slow progression of CKD and reduce risk for future cardiovascular events.