Is Heart Failure with Preserved Ejection Fraction a Kidney Disorder?

Curr Hypertens Rep. 2019 Oct 10;21(11):86. doi: 10.1007/s11906-019-0993-0.

Abstract

Purpose of review: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome of exertional intolerance, cardiac dysfunction, and fluid overload and is associated with significant morbidity and mortality.

Recent findings: As our understanding of this syndrome has evolved, we are beginning to recognize the similarities and associations with chronic kidney disease (CKD). Salt and fluid retention are common in CKD and may be the sentinel event leading ultimately to the syndrome of HFpEF. Mechanisms linking both disease states include hypervolemia, inflammation, and endothelial dysfunction, which are also common to comorbidities that drive both HFpEF and CKD. In this review, we will discuss recent clinical research focusing on HFpEF, CKD, and comorbidities including hypertension and diabetes mellitus. We will review strategies for volume management and novel therapeutic approaches with new classes of drugs, including sodium-glucose cotransporters and angiotensin receptor/neprilysin inhibitors, which may work through targeting of both the heart and the kidney. Lastly, we emphasize why focusing on the alleviation of factors provoking renal injury and slowing the progression of renal dysfunction may provide the most therapeutic benefit in patients who have been diagnosed with HFpEF.

Keywords: Ejection fraction; Heart failure; Kidney; Renal insufficiency.

Publication types

  • Review

MeSH terms

  • Cardiovascular Agents / therapeutic use*
  • Comorbidity
  • Diabetes Complications / epidemiology
  • Diabetes Complications / physiopathology
  • Endothelium, Vascular / physiopathology*
  • Heart Failure / drug therapy
  • Heart Failure / epidemiology
  • Heart Failure / physiopathology*
  • Humans
  • Hypertension / drug therapy
  • Hypertension / epidemiology
  • Hypertension / physiopathology
  • Renal Insufficiency, Chronic / epidemiology
  • Renal Insufficiency, Chronic / physiopathology*
  • Risk Factors
  • Stroke Volume / physiology*

Substances

  • Cardiovascular Agents