The report summarizes discussions and conclusions from the 2024 KDIGO Controversies Conference on Kidney Disease and Heart Failure, which convened international experts in nephrology, cardiology, and related disciplines to examine advances and ongoing challenges in caring for patients affected by both conditions.

Heart failure and chronic kidney disease frequently coexist and significantly worsen patient outcomes. Approximately 10–30% of individuals with chronic kidney disease have heart failure, while 30–60% of patients with heart failure also have kidney disease. When these conditions occur together, risks of hospitalization, disease progression, and death increase substantially.

“For too long, we have drawn artificial lines between the heart and the kidney — in our clinics, our guidelines, and our clinical trials. The reality for our patients is that these two conditions do not exist in isolation; they fuel one another, and care that addresses only one organ inevitably falls short,” said Carolyn S.P. Lam, MBBS, PhD (Singapore), Co-Chair of the conference. “This conference brought nephrologists and cardiologists together not simply to exchange knowledge, but to forge a genuinely integrated path forward — one that reflects how these diseases actually behave in the people we treat. Our discussions highlighted how overlapping pathophysiology demands a more united approach to care.”

Discussions addressed diagnostic challenges when both conditions are present, including interpreting biomarkers such as natriuretic peptides and serum creatinine, and distinguishing fluid overload related to heart failure from that caused by abnormal kidney function. Conference participants also reviewed therapies that benefit both heart and kidney outcomes, including emerging agents such as nsMRAs and glucagon-like peptide-1 receptor agonists. The group also emphasized important knowledge gaps, particularly for patients with advanced kidney disease, who remain underrepresented in cardiovascular trials.

“Data from the last few years has demonstrated that the therapeutic landscapes of heart failure and chronic kidney disease have converged, with many of the same medications now improving outcomes for both organs,” said Nisha Bansal, MD (United States), Co-Chair of the conference. “The challenge before us is to ensure that patients are started on, and remain on, these important treatments. It also underscores the need for closer collaboration between cardiology and nephrology when caring for patients living with both conditions.”

The full conference report is available on the KDIGO conference webpage, in Kidney International, and in JACC: Heart Failure.