In 2017, KDIGO held a Controversies Conference on Heart Failure in CKD, and since then there have been significant advances in understanding heart failure pathophysiology and diagnosis. However, much remains unknown regarding the pathophysiology, diagnosis, and treatment of patients with both heart failure and kidney disease, leading to critical treatment gaps. In particular, heart failure with preserved ejection fraction, the most prevalent heart failure subtype, remains incompletely understood in patients with kidney disease.

New therapies, such as sodium-glucose cotransporter-2 inhibitors (SGLT2i), are now widely available to improve both heart failure and kidney outcomes. Yet there are unique challenges in their implementation in patients with kidney disease. There is also a need to better understand whether other novel heart failure treatment approaches can be applied to patients with kidney disease and whether more individualized approaches with kidney replacement therapy are needed for this population. Finally, this is an opportune time to plan the conduct and design of future clinical trials of patients with kidney disease and heart failure, with special attention to studying diverse populations to ensure equitable healthcare advancement.

Dr. Nisha Bansal (University of Washington, United States) and Dr. Carolyn Lam (National Heart Centre Singapore and Duke-National University of Singapore, Singapore) co-chaired this conference. Four breakout groups addressed the pathophysiology, diagnosis, treatment, and clinical trials for patients with heart failure and kidney disease. Each breakout group comprehensively covered all types of heart failure (with reduced, mildly reduced, and preserved ejection fraction) and all stages of kidney disease.

Plenary Presentation Recordings