What is the connection between heart failure and the kidneys?

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According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), heart disease is the most common cause of death in people with kidney disease.

People with CKD have an above-average risk of developing heart failure. This is partly because CKD and heart failure have two common causes: diabetes and high blood pressure.

Research suggests that having one of these two conditions can increase the progression of the other. If a person has both heart failure and CKD, they have an increased risk of:

• hospitalization or rehospitalization
• the need for intensive care
• the need for kidney replacement therapy
• death

How does kidney failure affect the heart?

According to the Centers for Disease Control and Prevention (CDC), CKD increases pressure on the heart because the kidneys need more blood than they usually would. As a result, the heart has to pump blood more intensely, which can damage the heart over time.

Can heart failure or heart disease affect the kidneys?

Heart failure can contribute to reduced kidney function.

This is because, when a person has heart failure, the kidneys may not receive enough blood. Additionally, some heart failure medications can cause kidney dysfunction.

Risk factors for a condition are things that can increase a person’s risk of developing it. The NIDDK details several risk factors for heart disease and CKD. The table below summarizes them.

Who is more likely to develop CKD and heart failure?

Anyone can develop CKD and heart failure. However, members of African American, Hispanic, Latino, American Indian, and Alaska Native populations are more likely to develop CKD.

When someone has heart failure and CKD, they may develop symptoms of both conditions. Symptoms of heart failure include:

• shortness of breath
• chest pain
• heart palpitations
• fatigue
• appetite loss
• anxiety
• sweating

CKD may not cause symptoms for some time. However, it can cause a wide range of symptoms, including:

• nausea
• vomiting
• appetite loss
• weakness
• sleep problems
• muscle twitches or cramps
• decreased urination
• decreased mental sharpness
• swelling of feet and ankles
• itchy skin
• high blood pressure

Like heart failure, CKD can cause chest pain, fatigue, and shortness of breath. In people with both conditions, the symptoms may be particularly acute.

If a person has heart failure, a doctor may order a blood test to check the level of a molecule called brain natriuretic peptide, which will rise during heart failure.

Blood tests can also show how well the kidneys are working.

Tests to diagnose CKD include:

• blood tests to check how well the kidneys are filtering waste
• urine tests for albumin, a protein that the kidneys can release into the urine when they have damage

To diagnose heart failure, a doctor will perform an electrocardiogram, which uses sensors to record the heart’s activity.

There has not been much research on the specific treatment needs of heart failure in the context of CKD. Nonetheless, some evidence suggests that the following medications can help:

• beta-blockers
• aldosterone receptor antagonists
• diuretics

It is important to note that some heart failure medications can worsen symptoms of CKD. These include lithium, aminoglycosides, and nonsteroidal anti-inflammatory drugs.

Treating CKD

Treatment for CKD involves managing the underlying cause, such as high blood pressure or diabetes.

The mainstay of end stage CKD treatment is renal replacement therapy. This could involve a kidney transplant or the use of a dialysis machine, which functions like a kidney.

The NIDDK notes that if a person has CKD or heart disease, a doctor will prescribe medications to help manage the blood glucose levels and blood pressure.

It may be possible for people with CKD to reduce their risk of heart failure. People should also:

• avoid missing medical appointments
• take any medications their doctor prescribes
• make efforts to maintain healthy blood pressure, blood glucose, and blood cholesterol levels
• make efforts to reach or maintain a healthy BMI
• be physically active
• eat plenty of fruits, vegetables, and whole grains
• consume less sodium

According to a 2019 study, having CKD can significantly worsen the outlook for people with heart failure.

In particular, having CKD increases the mortality rate, hospitalization rate, and hospital readmission rate of people with heart failure.

An individual may have several questions about kidney disease and heart failure. The NIDDK suggests the following useful questions to ask the doctor:

• What is my blood pressure, and what should it be?
• What are my cholesterol levels, and what should they be?
• How often should I check my blood pressure?
• Which medications should I take for blood pressure?
• What diet can help prevent kidney disease and heart failure?
• What exercise plan can help prevent kidney disease and heart failure?
• What can help with smoking cessation?

CKD is when someone has gradually worsening kidney function. Heart failure is when the heart does not pump enough blood to meet the body’s needs.

These conditions have some common risk factors, such as diabetes, high blood pressure, and a family history of the condition.

Additionally, having CKD can put pressure on the heart to pump more blood to the kidneys. Heart failure can mean that the kidneys do not receive enough blood.