IMR Press / RCM / Volume 21 / Issue 1 / DOI: 10.31083/j.rcm.2020.01.24
Open Access Review
Management of heart failure in patients with end-stage kidney disease on maintenance dialysis: a practical guide
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1 University of Michigan Medical School and Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48109, USA.
*Correspondence: (Nicole M. Bhave)
Rev. Cardiovasc. Med. 2020, 21(1), 31–39;
Submitted: 1 March 2020 | Accepted: 5 March 2020 | Published: 30 March 2020
(This article belongs to the Special Issue Cardiovascular disorders in chronic kidney disease)
Copyright: © 2020 Joseph et al. Published by IMR press.
This is an open access article under the CC BY-NC 4.0 license

End-stage kidney disease (ESKD) and heart failure (HF) often coexist and must be managed simultaneously. Multidisciplinary collaboration between nephrology and cardiology is critical when treating patients with such complicated physiology. There is no “one-size-fits-all” approach to the evaluation of patients with new left ventricular systolic dysfunction, and diagnostic testing should be adapted to an individual’s risk factors. Guideline-directed medical therapy (GDMT) for systolic heart failure should be employed in these patients. While limited randomized data exist, observational data and post hoc analyses suggest that GDMT, including renin angiotensin aldosterone system inhibitors, is associated with improved cardiovascular outcomes and can be safely initiated at low doses with close monitoring of kidney function in this population. Volume status is typically managed through ultrafiltration, so close communication between cardiology and nephrology is necessary to achieve a patient’s optimal dry weight and mitigate intradialytic hypotension. Patient education and engagement regarding sodium and fluid restriction is crucial, and symptom burden should be reassessed following changes to the dialysis regimen.

Heart failure
end-stage kidney disease
Figure 1.
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