NephMadness 2015: Commentary on The Heart and Kidney Connection from Bhupinder Singh

BSinghBhupinder Singh, MD is currently an Assistant Professor of Medicine at Creighton University School of Medicine (Phoenix Campus). Currently he serves on the Board (president) of the Cardiorenal Society of America. He is the executive director of Research and Medical Affairs, ZS Pharma and a board member (vice president) of Twinepidemic, Inc.

This is an invited commentary on the heart and kidney connection.

Chronic kidney disease (CKD) and heart failure (HF) have several common features:

  • Millions of people in the US have either one or both conditions
  • Both CKD and HF are frequently underdiagnosed
  • One condition can worsen the other (cardiorenal syndrome)
  • Treatment options are limited
  • Innovation has been lacking, and several promising clinical trials have failed
  • Mortality and morbidity, as well as associated costs are high
  • Co-management of these conditions, which is a necessary component has been sub-optimal
  • There is confusion regarding the optimum nutritional intake (sodium, potassium, protein, micronutrients, etc) in cardiorenal syndrome
  • Both conditions require closer follow up and monitoring than is being provided in our current healthcare environment.

Up until now, RAAS inhibition has been the mainstay of therapy, especially for proteinuric CKD and systolic heart failure. Given that the pathophysiology of these conditions is quite similar (characterized by inflammation, fibrosis, oxidative stress, hormonal and cytokine abnormalities), it is imperative that the nephrology and cardiology research communities work together on developing better treatment options.

There is hope on the horizon. Remote monitoring, point of care testing, wearable health devices and other advancements in technology could help improve care of this complicated disease state where managing patients during a “snap-shot” visit every few months is sub-optimal. A number of drugs in development like neprilysin inhibitors, Galectin-3 antagonist, new mineralocorticoid receptor agonists, new drugs for management of sodium, potassium and phosphate balance may all play a role in eventual management of cardiorenal disease.

Finally, perhaps a concept of setting up “Cardio Renal Clinics” should also be considered.

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