Challenges of heart failure treatment in patients with chronic kidney disease

Heart failure (HF) is one of the most common and consequential conditions encountered in clinical practice. It frequently coexists with chronic kidney disease (CKD), a highly prevalent and economically burdensome condition. The presence of CKD in patients with HF is an independent risk factor for HF-related hospitalization and death. Clinicians often face significant challenges when treating this patient population because many standard, guideline-directed medical therapies for HF can worsen kidney function. As a result, evidence-based HF treatments are frequently underutilized. Moreover, patients are often referred back and forth between cardiologists and nephrologists in attempts to optimize therapy and control symptoms, often without significant improvement in their condition. The purpose of this article is to examine the safety and efficacy of standard HF treatments among patients with CKD based on the available evidence, with the goal of supporting clinical decision-making and emphasizing the importance of an interdisciplinary approach.