Figure 1
Comparison of global mortality and change in age-standardised death rates from selected noncommunicable diseases (12).
Adapted from https://zenodo.org/records/8312881. Author: Boris Bikbov, Scientific-Tools. Org. Title: Comparison of global mortality from selected noncommunicable diseases. This figure is licensed under a Creative Commons Attribution NoDerivatives License: https://creativecommons.org/licenses/by-nc-nd/4.0/
Table 1
Heart – Kidney connections.
| KIDNEY | CARDIAC CONSEQUENCES/ASSOCIATIONS |
|---|---|
| Albuminuria/proteinuria | Major risk factor for cardiovascular disease (CVD) (15) and cardiovascular (CV) mortality (16) |
| Chronic kidney disease (CKD) | More deaths from CVD than kidney failure Major risk factor for CVD 17–50% have heart failure (6, 17, 18, 19) |
| Acute kidney injury (AKI) | Due to heart failure Cause of heart failure (6, 18, 19, 20, 21, 22) |
| Worsening renal function | Due to heart failure Cause of heart failure (17) |
| Kidney transplant (23) | Heart diseases are the leading cause of death Heart disease can make candidates ineligible for a transplant or delay transplantation Challenges with cardiac medication dosing and interaction with immunosuppressants |
| Haemodialysis (17, 23) | Heart disease is a major cause of death Sudden cardiac death Atrial fibrillation Heart failure (17) Ischaemic heart disease Valvular heart disease Challenges with therapy/medication dosing and approval to use |
| Vascular access for dialysis | Haemodialysis catheters are a risk for infective endocarditis Arteriovenous Fistulas may contribute to heart failure (23) |
| HEART | KIDNEY CONSEQUENCES |
| Ischaemic heart disease | Contrast-induced acute kidney injury (AKI) AKI post bypass surgery Atheroembolic kidney disease (19, 24, 25) |
| Heart failure | 49% have kidney disease (albuminuria or reduced glomerular filtration rate [GFR]) (17, 19, 25) |
| Atrial fibrillation | Therapeutic challenges especially in haemodialysis (26) |
| Aortic stenosis | Progression on dialysis (17) |
| Rheumatic fever | AKI, post-infectious glomerulonephritis (20, 21) |
| Peripartum cardiomyopathy | AKI |
| Cardiac surgery | AKI |
| Heart transplant | High risk of CKD, KF (heart function, side effect of immunosuppression) |
| Infective endocarditis | Immune complex glomerulonephritis Ischaemic acute tubular necrosis (ATN) (sepsis, CRS) Nephrotoxic ATN (aminoglycosides) Acute tubulointerstitial nephritis (beta-lactam antibiotics) Renal infarcts Renal abscesses secondary septic emboli |
| SYSTEMIC DISEASES IMPACTING KIDNEY AND HEART | |
| Diabetes mellitus (DM) | 1 in 3 have CKD Major risk factor for CVD Overlap DM, CKD, CVD (cardio-kidney-metabolic syndrome [CKM] in around 1:20 people in US (CKM) 9 in10 people with Diabetes and CKD dies of heart disease before developing kidney failure (6, 27) |
| Hypertension | 1 in 5 have CKD Major cause of heart failure, CVD (27) |
| Overweight/obesity | Risk factor for worsening CKD, heart disease (27) |
| Sepsis | Important cause of kidney and heart failure (20) |
| Autoimmune and other related diseases: SLE, vasculitis, sarcoidosis | Major cause of glomerulonephritis, can cause pericarditis, cardiomyopathy, arrhythmias, conduction abnormalities |
| Cancers (28) | Drugs may be toxic to kidney and heart Tumour lysis syndrome causing AKI and cardiac arrhythmias secondary to hyperkalaemia |
| Preeclampsia | Short- and long-term risks of kidney and heart disease (29) |
| Low birth weight, preterm birth | Long-term risk of hypertension, CKD, heart disease, DM (30, 31) |
| Genetic conditions | Fabry disease, amyloidosis (32) |
| SOCIAL DETERMINANTS OF HEALTH (10, 30, 33) | |
| Poverty | CKD, AKI, rheumatic fever, heart failure, IHD |
| Nutrition | CKD, AKI, IHD, heart failure, MIA syndrome |
| Education | CKD, AKI, IHD, heart failure |
| Race, ethnicity | CKD, heart failure |
| Sex | CKD, AKI, peripartum cardiomyopathy |
| Geography | CKD, AKI, heart failure, IHD |
| Climate change | CKD, AKI, kidney failure, heart failure, IHD |
| Lifestyle | CKD, heart failure, IHD |
[i] AKI: acute kidney injury; ATN: acute tubular necrosis; CKD: chronic kidney disease; CKM: cardiovascular-kidney-metabolic; CRS: cardiorenal syndrome; CV: cardiovascular; CVD: cardiovascular disease; DM: diabetes mellitus; GFR: glomerular filtration rate; IHD: ischaemic heart disease; KF: kidney failure; MIA: malnutrition-inflammatory-atherosclerosis; SLE: systemic lupus erythematosus.
Figure 2
Mortality increases with heart failure and worsening kidney function (37).
Adapted from the Journal of the American College of Cardiology, volume 78, issue 4, author: Patel RB et al., title: Kidney function and outcomes in patients hospitalized with heart failure, pages 330–343, Copyright 2021, with permission from Elsevier.
Figure 3
Examples of factors contributing to heart and kidney risk over the life course (88)
Adapted from https://www.sciencedirect.com/science/article/pii/S2468024919315864. Authors: Valerie A. Luyckx, David Z.I. Cherney, Aminu K. Bello. Title: Preventing CKD in developed countries. This figure is licensed under a CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Figure 4
Cardiovascular-kidney-metabolic syndrome (106).
Adapted from Current Problems in Cardiology, volume 49, issue 2, author: Sebastian SA et al., Title: Cardiovascular-kidney-metabolic (CKM) syndrome: A state-of-the-art review, page 102334, Copyright 2023, with permission from Elsevier.
Figure 5
Social determinants of health and CKM.
Figure 6
Cardiovascular risk stratified by presence or absence of kidney disease and/or albuminuria (42).
Adapted from the European Journal of Preventive Cardiology, volume 30, issue 1, author: Matsushita K et al., Title: Including measures of chronic kidney disease to improve cardiovascular risk prediction by SCORE2 and SCORE2-OP, pages 8–16, Copyright 2022, with permission from Oxford University Press.
Figure 7
Holistic approach to CKD and CVD treatment and risk modification (137).
ASCVD: atherosclerotic cardiovascular disease; BP: blood pressure; CCB: calcium channel blocker; CKD: chronic kidney disease; CKD-MBD: chronic kidney disease–mineral and bone disorder; CVD: cardiovascular disease; eGFR: estimated glomerular filtration rate; GLP-1 RA: glucagon-like peptide 1 receptor agonist; HTN: hypertension; KDIGO: Kidney Disease Improving Global Outcomes; MRA: mineralocorticoid receptor antagonist; ns-MRA: non-steroidal mineralocorticoid receptor antagonist; PCSK9i: proprotein convertase subtilisin/kexin type 9 inhibitor; RAS: renin-angiotensin system; SBP: systolic blood pressure; SGLT2i: sodium-glucose cotransporter-2 inhibitor.
Adapted from https://www.kidney-international.org/article/S0085-2538(23)00766-4/fulltext. Author: Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. Title: KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. This figure is licensed under the CC BY-NC-ND license http://creativecommons.org/licenses/by-nc-nd/4.0/
Table 2
Policy solutions.
| POLICY LEVEL | ||
|---|---|---|
| Global/National Policy | Achieve SDGs and tackle climate change |
|
| Address social determinants of health |
| |
| Understand disease burden | Recognize CKD as a contributor to the global disease burden and as an important modulator of CVD risk | |
| Public health strategies |
| |
| NCD policies and planning |
| |
| Health systems level | Track disease burden and costs |
|
| Strengthen Integrated care |
| |
| Support quality clinical care |
| |
| Enable effective workforce strategies |
|
Table 3
Informing and empowering patients.
| FACTORS THAT SHOULD BE ADDRESSED TO EMPOWER PATIENTS AND CARE GIVERS | RECOMMENDATIONS |
|---|---|
| Peer mentoring | Establish support groups specifically tailored for individuals living with both CKD and CVD, as well as their care partners. These groups can provide a platform for sharing experiences, coping strategies, and emotional support. |
| Patient-centred research initiatives | Involve patients and care partners in the design and implementation of research initiatives focused on CKD and CVD. Their insights can offer valuable perspectives and ensure that research efforts address their specific needs and concerns. |
| Education and information resources | Develop educational materials and resources that provide comprehensive information about managing both CKD and CVD. These resources should be easily accessible and available in multiple formats to accommodate different learning preferences. |
| Advocacy and policy engagement | Empower patients and care partners to advocate for policies and initiatives that improve access to quality care, treatment options, and support services for individuals living with both CKD and CVD. |
| Care coordination and communication | Enhance communication and collaboration between healthcare providers, patients, and care partners to ensure continuity of care and a holistic approach to managing both conditions. Encourage open dialogue and shared decision-making processes. |
| Addressing social and financial barriers | Recognise and address the social determinants of health and financial challenges that may impact individuals living with both CKD and CVD and their families and/or caregivers. Provide resources and support to help navigate these barriers effectively. |
| Promote self-management and empowerment | Offer self-management programmes and resources that empower patients and care partners to take an active role in managing their health and wellbeing. This can include lifestyle modification strategies, medication adherence support, and self-monitoring tools. |
| Cultural competency and diversity | Ensure that support services and resources are culturally competent and inclusive of diverse perspectives and backgrounds. This can help foster a sense of belonging and improve the overall experience for patients and care partners. |
| Regular feedback and evaluation | Establish mechanisms for collecting feedback from patients and care partners about their experiences with healthcare services and support programmes. Use this feedback to continuously improve and tailor interventions to meet their evolving needs. |
| Holistic wellness approach | Recognise the interconnectedness of physical, emotional, and social wellbeing in individuals living with both CKD and CVD. Adopt a holistic approach to care that addresses all aspects of health and promotes overall wellness. |