Key result
Review details irbesartan and evolving background therapies for HFpEF and CKD in CKM syndrome.
Why the study?
Evolving concepts in HFpEF pathogenesis, rising HFpEF prevalence, and the bidirectional relationship between HF and CKD have prompted a shift in treatment approaches and a reassessment of irbesartan within cardiovascular-kidney-metabolic syndrome.
This review discusses the shifting paradigm in managing heart failure with preserved ejection fraction and chronic kidney disease within the cardiovascular-kidney-metabolic syndrome framework, highlighting the therapeutic role and metabolic benefits of irbesartan.
Answers are grounded in this paper and cite their sources.
May inform irbesartan use in HFpEF-CKD overlap; leaves open dedicated outcome trials in cardiovascular-kidney-metabolic syndrome.
The paper is focused on a shift in approaches to treatment of heart failure (HF) and chronic kidney disease (CKD) as components of cardiovascularkidneymetabolic ( CKM) syndrome. It reviews evolution of concepts regarding the pathogenesis of heart failure with preserved ejection fraction (HFpEF) and, consequently, changing views on the role of reninangiotensin system activation in the development of this HF type. Current epidemiological data demonstrating a substantial increase in HFpEF prevalence are presented. The current classification of CKM syndrome which provides the basis for selecting background therapy at each stage of the syndrome, is described. The key role of abnormal adipose tissue in HFpEF development, as well as its important contribution to development and progression of CKD, is discussed. Significance of the bidirectional relationship between HF and CKD causing progression of both diseases is being discussed. A shift in approaches to background therapy for CKD and a place of irbesartan in the current management of patients with CKM syndrome and impaired kidney function are on the carpet. Data on the potential modification of treatment response in overweight and obese patients are presented. The findings of the I PRESERVE trial assessing irbesartan effects in patients with HFpEF, as well as the results of two pivotal irbesartan trials in patients with type 2 diabetes at high risk of CKD onset or progression, are discussed in a modern light. Data on the role of PPARγ activation in a beneficial effect of irbesartan on metabolic parameters, as well as its effects on uric acid levels in patients with hyperuricemia, are presented. KEYWORDS: cardiovascularkidneymetabolic syndrome, heart failure, chronic kidney disease, irbesartan. FOR CITATION: Gilyarevsky S.R., Akhmetova K.R., Golschmidt M.V., Shchedrina A.Yu. Heart failure and chronic kidney disease in the structure of cardiovascular-kidney-metabolic syndrome: a shift in paradigm and treatment approaches. Russian Medical Inquiry. 2026;10(9):621–628 (in Russ.). DOI: 10.32364/2587-6821-2026-10-9-5
No takes yet. Share an insight, caveat, or question.
Gilyarevsky et al. (2026) conducted a review in Cardiovascular-kidney-metabolic (CKM) syndrome, heart failure (HFpEF), and chronic kidney disease (CKD). Irbesartan was evaluated. Irbesartan and shifting background therapy approaches are reviewed for managing heart failure with preserved ejection fraction and chronic kidney disease in cardiovascular-kidney-metabolic syndrome.
Synapse has enriched 10 related papers. Consider them for comparative context: