Can kidney failure cause heart failure?

From the Guidelines

Yes, kidney failure can cause heart failure, as the two conditions are closely linked through several mechanisms, including fluid overload, electrolyte imbalances, and hypertension, which can disrupt normal heart function and rhythm. When kidneys fail, they cannot properly filter fluid and waste from the blood, leading to fluid overload that puts strain on the heart. Kidney disease also causes electrolyte imbalances, particularly potassium and calcium, which can disrupt normal heart rhythm and function. Additionally, kidney failure often leads to hypertension (high blood pressure), forcing the heart to work harder and potentially causing left ventricular hypertrophy. Chronic kidney disease also promotes atherosclerosis and can cause anemia due to decreased production of erythropoietin, further stressing the cardiovascular system. This connection is so significant that the term "cardiorenal syndrome" describes the simultaneous dysfunction of both organs, where failure in one can initiate or worsen failure in the other, as noted in a study published in the European Heart Journal 1.

Some key points to consider in the relationship between kidney failure and heart failure include:

• The activation of neurohumoral mechanisms, such as the renin-angiotensin-aldosterone system, which can contribute to renal deterioration and cardiac stress 1.
• The use of diuretics, which can reduce intravascular volume and renal perfusion, potentially exacerbating renal deterioration 1.
• The importance of monitoring renal function in patients with heart failure, as renal decline can be a predictor of mortality and morbidity 1.
• The need for early intervention and management of both conditions simultaneously to reduce the risk of progression to kidney failure and heart failure.

Overall, the relationship between kidney failure and heart failure is complex and bidirectional, and managing both conditions requires a comprehensive approach that takes into account the potential interactions and complications between the two. As noted in a recent review published in the British Journal of Pharmacology, regular monitoring of renal function and adjustment of prescribed drugs can help prevent or ameliorate renal decline and reduce the risk of hospital admission 1.

From the Research

Kidney Failure and Heart Failure Relationship

• Kidney failure can contribute to the development of heart failure, as evidenced by the close relationship between the two organs in the clinical syndrome of heart failure (HF) 2.
• The pathophysiology of this relationship is multifactorial, involving reduced renal perfusion and venous congestion, among other factors 2.
• Renal dysfunction is a common occurrence in all phenotypes of HF, and its presence is associated with higher mortality and morbidity 2.

Mechanisms of Kidney-Heart Interaction

• The heart can cause kidney disease, and the kidney can cause heart disease, as illustrated by examples such as dilated cardiomyopathies leading to renal failure and renal failure increasing the risk of cardiovascular diseases 3.
• Uremic toxins, which accumulate in the circulation when kidney injury occurs, can target other tissues, including the cardiovascular system, leading to a loss of body functions and increased risk of cardiovascular injuries 4.
• The accumulation of uremic toxins such as p-cresyl sulfate, indoxyl sulfate, and inorganic phosphate can have toxic effects on the cardiovascular system, which are difficult to remove by dialysis 4.

Clinical Implications

• Patients with severe heart failure often exhibit signs of impaired renal function, and the use of angiotensin-converting enzyme (ACE) inhibitors can potentially worsen renal function, although this is rare and can be managed with precautions 5.
• Guideline-directed medical therapies for heart failure are often underused in patients with kidney disease, despite the fact that these therapies can be beneficial even in patients with reduced kidney function 6.
• Mortality is higher in patients with lower admission estimated glomerular filtration rate (eGFR) groups, and there is a steep covariate-adjusted association between admission eGFR and mortality across different subgroups of heart failure patients 6.