Kidney Week 2025 Annual Meeting-Heart Failure Across the Spectrum of CKD: Mechanisms and Treatment

Video Transcription

Video Summary

The session introduces a symposium on heart failure in chronic kidney disease (CKD), emphasizing that about half of heart failure patients have CKD and outcomes worsen markedly when both coexist. Speakers note that guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) is highly effective but underused in CKD due to concerns about hyperkalemia, hypotension, and creatinine rise. Heart failure with preserved ejection fraction (HFpEF) is increasingly common in CKD and historically lacked proven disease-modifying therapy.<br /><br />Professor Vijay Kher reviews cardiorenal syndrome as a bidirectional “crosstalk” driven by shared risks (age, diabetes, hypertension) and mechanisms including venous congestion, neurohormonal activation, inflammation, oxidative stress, and endothelial dysfunction. He highlights evidence that central venous pressure and renal venous congestion predict worsening kidney function more than cardiac output. He distinguishes “pseudo-AKI” (creatinine rise during successful decongestion without tubular injury biomarkers and without worse outcomes) from true AKI. He also presents emerging mechanistic research suggesting a cardiac arrest–related protein (CSRP3) may trigger AKI-to-CKD transition via renal uptake mechanisms.<br /><br />Dr. Robert Mentz summarizes HFrEF “quad therapy” (ARNI/ACEi/ARB, beta blockers, MRAs, SGLT2 inhibitors), stressing consistent cardiovascular benefit across CKD stages despite limited trial inclusion of advanced CKD. He discusses expected eGFR “dip” with ARNI and SGLT2 inhibitors that does not negate benefit, and encourages re-challenging therapies rather than permanently discontinuing them.<br /><br />A recorded talk by Dr. Wendy McCallum focuses on dialysis and transplant patients, noting diagnostic challenges (nonspecific symptoms, high baseline natriuretic peptides, echo timing relative to dialysis). Evidence is strongest for beta blockers in dialysis; data for ARNI and other agents are emerging. Dialysis strategies (including peritoneal dialysis for gentler volume control) and AV fistula effects are reviewed.<br /><br />Dr. Devashish Banerjee outlines future directions beyond GDMT: aldosterone synthase inhibitors, anti-inflammatory therapies, incretin-based weight-loss/diabetes drugs, remote congestion monitoring, and delivery models to address implementation gaps and health inequities.

Asset Subtitle

Moderator(s): Adeera Levin, Prem Varma

Presentation(s):

Kidney Diseases in Heart Failure: Burden of Disease and Pathophysiology - Vijay Kher
Considerations for Heart Failure Guideline-Directed Medical Therapy Across the Spectrum of CKD - Robert Mentz
Approaches to Heart Failure Diagnosis and Treatment in Dialysis and Kidney Transplant Recipients - Wendy McCallum
Cardiorenal Syndrome: Key Priorities for the Next Decade - Debasish Banerjee

ASN thanks the American Heart Association Council on the Kidney in Cardiovascular Disease for assistance with this session.

Meta Tag

Date 11/7/2025

Pathway 1 Hypertension and Cardiorenal Disorders

Pathway 2 CKD Non-Dialysis

Session ID 504509

Keywords

heart failure

chronic kidney disease

cardiorenal syndrome

HFrEF

HFpEF

guideline-directed medical therapy

quadruple therapy

ARNI ACEi ARB

beta blockers

mineralocorticoid receptor antagonists

SGLT2 inhibitors

hyperkalemia

venous congestion

pseudo-AKI

dialysis and transplant heart failure