IMR Press / RCM / Volume 23 / Issue 2 / DOI: 10.31083/j.rcm2302069
Open Access Review
Interrelation between heart failure with preserved ejection fraction and renal impairment
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1 King’s Kidney Care, King’s College Hospital, SE5 9RS London, UK
2 Centre for Nephrology, Urology and Transplantation, King’s College London, SE5 9NU London, UK
3 Heart Imaging Centre, Royal Brompton and Harefield Hospitals, SW3 6NP London, UK
*Correspondence: (Eirini Lioudaki)
Academic Editor: Giuseppe Coppolino
Rev. Cardiovasc. Med. 2022, 23(2), 69;
Submitted: 15 November 2021 | Revised: 5 January 2022 | Accepted: 19 January 2022 | Published: 18 February 2022
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Heart failure with preserved ejection fraction (HFpEF) and chronic kidney disease (CKD) are global diseases of increasing prevalence and are frequent co-diagnoses. The two conditions share common risk factors and CKD contributes to HFpEF development by a variety of mechanisms including systemic inflammation and myocardial fibrosis. HFpEF patients with CKD are generally older and have more advanced disease. CKD is a poor prognostic indicator in HFpEF, while the impact of HFpEF on CKD prognosis is not sufficiently investigated. Acute kidney injury (AKI) is common during admission with acute decompensated HFpEF, but short and long-term outcomes are not clear. Pharmacological treatment options for HFpEF are currently minimal, and even more so limited in the presence of CKD with hyperkalaemia being one of the main concerns encountered in clinical practice. Recent data on the role of sodium-glucose cotransporter 2 (SGLT2) inhibitors in the management of HFpEF are encouraging, especially in light of the abundance of evidence supporting improved renal outcomes. Herein, we review the pathophysiological links between HFpEF and CKD, the clinical picture of dual diagnosis, as well as concerns with regards to renal impairment in the context of HFpEF management.

heart failure with preserved ejection fraction
chronic kidney disease
end-stage renal disease
acute kidney injury
Fig. 1.
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