Diseases affecting the heart and kidneys, such as chronic kidney disease (CKD) and heart failure (HF), fall on an interconnected spectrum of cardiovascular, renal and metabolic (CVRM) conditions.
CKD is a serious, progressive condition that gradually decreases a person’s kidney function.1 Nearly 850 million people worldwide are affected by CKD and the majority are still undiagnosed — in fact, nine out of 10 people with CKD don’t even know they have it.2,3 A silent disease in its early stages means CKD is often diagnosed late and left untreated for too long even though it affects more than 10% of the general population worldwide.4,5 There is currently no cure for CKD, and if the disease progresses to kidney failure, patients need dialysis or kidney transplants.6
CKD is expected to become the world’s fifth leading cause of mortality by 2040, making this condition a growing public health problem that presents a significant burden for patients and health systems.7,8 For patients with CKD, it’s possible to slow the progression through early diagnosis and intervention.9
While CKD can be difficult to diagnose and treat on its own, it can also increase the risk of cardiovascular (CV) diseases. Research continues to show the connection between cardiovascular and renal conditions, and since the heart and kidneys are so closely related, CKD can cause or worsen CV conditions such as HF.10,11
Up to one in five patients diagnosed with CKD develops HF, making it the leading CV complication in CKD patients. CKD has also been associated with increased mortality in patients with HF. Within each type of ejection fraction (reduced, midrange, or preserved), patients with CKD had worse outcomes in both the short and long term (one and five years respectively).10-12
Patients more likely to develop CKD and HF typically have similar risk factors including diabetes, obesity, and hypertension.6,13,14 Once patients develop CKD and HF, they’re also likely to share similar related complications such as hyperkalaemia, or elevated potassium levels in the blood. 15 If these complications are severe and left untreated, they can be fatal and impact patients’ ability to continue guideline-recommended treatment options, such as RAAS inhibitors, an essential treatment for patients with CKD and/or HF in slowing the progression of CKD and reducing mortality in HF with reduced ejection fraction.16-18
The kidneys and heart are so closely connected that identifying CKD and intervening early can help slow disease progression, preserve renal function and reduce cardiovascular complications, which include heart failure.6
Diagnosing kidney disease early can help prevent other complications or comorbidities such as heart disease.5,9,19
Early interventions for CKD patients can help improve outcomes and quality of life.9 Identifying CKD early helps slow the progression of the disease and reduce its complications.5 Since HF and CKD are so closely connected, slowing the progression of one may help slow the progression of the other disease. 9,10,20
In the early stages of CKD and HF patients can implement certain lifestyle changes to help manage their condition and slow disease progression such as exercising, eating a healthy diet, stopping smoking and taking recommended medicines.9,21,22 As CKD progresses, care teams may shift to focusing on medical interventions, slowing disease progression, reducing cardiovascular risk and managing other complications.9 As HF progresses, physicians and patients may focus on reducing hospital readmissions, improving patients’ clinical condition, quality of life and implementing tools such as guideline-directed medical therapy (GDMT).16,22
In the late stages of CKD, physicians continue to work to slow kidney damage as well as begin to plan ahead with patients for possible treatments for kidney failure like dialysis.7,9 Once HF progresses to the late stage, the focus remains on medical interventions, continuing to leverage GDMT, and physicians may begin to assess patients for advanced HF therapies like transplants.22
Leveraging medical guidelines and guideline-directed medical therapies (GDMT) can help manage disease progression in CKD and HF patients.16,23
To overcome challenges and improve outcomes for patients with CKD and HF, we must continue to accelerate earlier detection and coordinated care that can help address the complexities and interconnectedness of cardiovascular and renal diseases. Medical guidelines and guideline-directed medical therapies are an important part of the solution as they help provide patient-centric recommendations for clinicians to diagnose and manage patients.
In the renal space, medical guidelines include the Kidney Disease Improving Global Outcomes (KDIGO) guidelines for CKD.23 For HF care teams, the 2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure and more recently the 2022 American College of Cardiology/American Heart Association/Heart Failure Society of America Guidelines for the Management of Heart Failure provide insights into the distinct types of HF, how to approach the disease, and how to diagnose and intervene early.22,24
Leveraging these guidelines in tandem offers direction on the management of both CKD and HF —effective implementation of the guidelines is key to saving lives.
Scientists and the healthcare system can improve outcomes by advancing the science, focusing on patient-centric care, delivering innovative treatments and championing the use of GDMT. By continuing to build our collective understanding of CKD and HF, we can improve pathways to better care.
Addressing diseases across the cardiorenal continuum, from earliest detection to late stage.
Our ambition is to fundamentally transform CVRM care and advance patient outcomes by unravelling the underlying causes of disease, developing diagnostic strategies and delivering innovative, life-changing solutions for the millions of people affected by this interconnected spectrum of diseases.
Through partnering with organisations such as the International Society of Nephrology to create a quick one-minute quiz that offers insight into whether people may be at risk for CKD to working with physicians and researchers to create better outcomes for people facing CKD and HF — we are working to build a deeper understanding of the cardiorenal connection.
“Scientific advances are revealing the connection between cardiovascular, renal and metabolic diseases, helping to drive earlier diagnosis and opportunities for integrated treatment approaches.”
Mene Pangalos, Executive Vice President, BioPharmaceuticals R&D, AstraZeneca
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References
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Veeva ID: Z4-49281
Date of preparation: November 2022