Cardionephrology from the point of view of the cardiologist: no more agree to disagree—getting to ‘yes’ for every patient

Whether one wants to or not, interactions between the heart and the kidneys exist and manifest nevertheless. Both from theoretical and clinical perspectives, it seems the need for a subspecialty of cardionephrology seems justified. Our editorial is a cardiologist perspective on the article by Diez and Ortiz published in Clinical Kidney Journal related to the ‘need for a cardionephrology subspecialty’. We analysed the historical similarities of the emergence of already ingrained clinical fields with the current needs in the cardionephrology sector. We motivated our approach based on novel cardiovascular diagnostic and therapeutic developments and significant pathophysiological differences from a cardiological perspective, accounting for the foundation of a novel sustainable medical field. One of the sensitive issues we also addressed was the operationality and applicability of the principles. We answered with some examples from high-risk debatable contexts the question of where a cardionephrologist should be integrated. Clarifying the operationality aspects would be a positive shift towards improving guidelines adherence in managing complex patients. In conclusion, we underline that the necessity of a cardionephrologist must be addressed from an operational and scientific perspective, with the ultimate goal of reducing mortality and complications in cardiorenal patients.