Cardiac Disease and Chronic Kidney Disease – a Fatal Alliance or New Opportunities of Treatment? (Review of the literature)

The incident of heart failure (HF) and chronic kidney disease (CKD) is increasing worldwide. The combination of these pathologies significantly increases the risk of mortality and reduces the quality of life (QOL) of patients. Cardiorenal syndrome (CRS) is a complex pathological condition which is characterized by interrelated damage to the heart and kidneys, in which dysfunction of one organ leads to dysfunction of the other. This comorbid pathology is a significant problem of modern medicine due to its high prevalence and significant impact on the prognosis of patients. There are five types of CRS. Type 1: acute cardiac syndrome, leading to acute renal failure. Type 2: chronic heart failure (CHF), leading to progressive CKD. Type 3: acute kidney damage, leading to acute heart failure. Type 4: CKD, leading to the development of CHF. Type 5: systemic diseases (e.g. sepsis) that simultaneously cause heart and kidney dysfunction. Modern pharmacotherapy of CRS is aimed to improve the function of both organs and the overall prognosis of patients. In particular, a positive effect on CRS course in modern studies has been demonstrated by: inhibitors of sodium-dependent glucose cotransporter type 2, which reduce blood glucose levels and have cardio- and nephroprotective properties (dapagliflozin demonstrated a significant reduction in the risk of progression of kidney disease, a reduction in the risk of cardiovascular death and hospitalization for CHF by 26% even in patients without diabetes); finerenone (a selective mineralocorticoid receptor antagonist), which reduces the inflammation and fibrosis in the kidneys and heart, improving the results of treatment of patients with CRS; glucagon-like peptide-1 receptor agonists have demonstrated a positive effect on the cardiovascular system and kidneys; sacubitril-valsartan is a combination drug that inhibits neprilysin and blocks angiotensin II receptors, reducing the risk of hospitalizations and mortality in patients with HF. The introduction of new drugs into clinical practice can significantly improve the prognosis and QOL of patients with CRS, but the prospect of further research and the development of new therapeutic strategies for this complex comorbid pathology remains extremely relevant.