The kidney in heart failure: an update
Open accessAbstract
Heart and kidney are closely related in the clinical syndrome of heart failure (HF). It is now sufficiently clear that renal dysfunction occurs frequently in all phenotypes of HF, and when present, it is associated with higher mortality and morbidity. While the pathophysiology is multifactorial, the most important factors are a reduced renal perfusion and venous congestion. Recent interest has focused on worsening renal function (WRF), a situation strongly related to mortality, but seemingly only when HF status deteriorates. Unfortunately, to date clinicians are unable to identify specifically those patients with a grim prognosis following WRF. Although much has been learned on cardiorenal interaction in HF, still more questions have been left unanswered. The coming decade should provide us with more dedicated epidemiologic, mechanistic, and controlled trials in HF patients with reduced renal function. An updated classification of the cardiorenal syndrome that incorporates recent evidence and points towards areas of interest and uncertainties, and areas where progress is needed could facilitate this process. Ultimately, this should lead to preventive and treatment strategies that can preserve renal function and associated outcome in patients with HF.
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Improvements in cardiac function resulting from GLP-1 receptor agonist treatment may contribute to favorable kidney outcomes by improving tissue perfusion.
“Moreover, improvements in cardiac function resulting from treatment with GLP-1 receptor agonists may also contribute to the favorable kidney outcomes seen with these treatments by improving tissue perfusion (20).”
From GLP-1 agonists in the treatment of chronic kidney disease in type 2 diabetes and obesity (2025) · cites this paper as [20]
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2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure
McDonagh, T. A., Metra, M., Adamo, M., Gardner, R. S., Baumbach, A., Böhm, M., Burri, H., Butler, J., Čelutkienė, J., Chioncel, O., et al. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehab368 · Cited by 13,344 · see citing works
Self-citation2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G. F., Coats, A. J. S., Falk, V., González-Juanatey, J. R., Harjola, V.-P., Jankowska, E. A., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw128 · Cited by 11,429 · see citing works
2016 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure
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Mullens, W., Damman, K., Harjola, V.-P., Mebazaa, A., Brunner-La Rocca, H.-P., Martens, P., Testani, J. M., Tang, W. H. W., Orso, F., Rossignol, P., et al. (2019) · European Journal of Heart Failure · doi:10.1002/ejhf.1369 · Cited by 1,119 · see citing works
Self-citationShah, S. J., Borlaug, B. A., Kitzman, D. W., McCulloch, A. D., Blaxall, B. C., Agarwal, R., Chirinos, J. A., Collins, S., Deo, R. C., Gladwin, M. T., et al. (2020) · Circulation · doi:10.1161/circulationaha.119.041886 · Cited by 436 · see citing works
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Beldhuis, I. E., Streng, K. W., Ter Maaten, J. M., Voors, A. A., van der Meer, P., Rossignol, P., McMurray, J. J. V., & Damman, K. (2017) · Circulation: Heart Failure · doi:10.1161/circheartfailure.116.003588 · Cited by 126 · see citing works
Self-citationImpact of Renal Impairment on Beta-Blocker Efficacy in Patients With Heart Failure
Kotecha, D., Gill, S. K., Flather, M. D., Holmes, J., Packer, M., Rosano, G., Böhm, M., McMurray, J. J. V., Wikstrand, J., Anker, S. D., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.09.059 · Cited by 71 · see citing works
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GLP-1 agonists in the treatment of chronic kidney disease in type 2 diabetes and obesity
Cooper, M. E., & van Raalte, D. H. (2025) · Journal of Clinical Investigation · doi:10.1172/jci194749 · Cited by 24 · see citing works
“Moreover, improvements in cardiac function resulting from treatment with GLP-1 receptor agonists may also contribute to the favorable kidney outcomes seen with these treatments by improving tissue perfusion (20).”
- Authors
- Damman, K., & Testani, J. M.
- Affiliations
- University Medical Center Groningen (NL)
- Yale University (US)
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-04-02
- Volume
- 36
- Issue
- 23
- Pages
- 1437-1444
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- PMC
- PMC4465636
- OpenAlex
- W2131962700
- Cited by
- 519
- References
- 2
- Citations by year
- 2026: 40 · 2025: 41 · 2024: 43 · 2023: 55 · 2022: 39 · 2021: 62 · 2020: 58 · 2019: 54 · 2018: 40 · 2017: 39 · 2016: 33 · 2015: 13
- FWCI
- 7.19
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- European Heart Journal (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute (K23HL114868, L30HL115790)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Keywords
- heart failure, renal dysfunction, cardiorenal syndrome, worsening renal function, cardiorenal interaction, venous congestion, mortality, prognosis, renal function preservation
- MeSH terms
- Forecasting, Glomerular Filtration Rate, Hemodynamics, Humans, Kidney Failure, Chronic, Terminology as Topic, Prognosis, Meta-Analysis as Topic, Biomarkers, Early Diagnosis, Acute Kidney Injury, Cardio-Renal Syndrome
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