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Is Heart Failure with Preserved Ejection Fraction a Kidney Disorder?

  • Mechanisms of Hypertension and Target-Organ Damage (JE Hall and ME Hall, Section Editors)
  • Published:
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Abstract

Purpose of Review

Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome of exertional intolerance, cardiac dysfunction, and fluid overload and is associated with significant morbidity and mortality.

Recent Findings

As our understanding of this syndrome has evolved, we are beginning to recognize the similarities and associations with chronic kidney disease (CKD). Salt and fluid retention are common in CKD and may be the sentinel event leading ultimately to the syndrome of HFpEF. Mechanisms linking both disease states include hypervolemia, inflammation, and endothelial dysfunction, which are also common to comorbidities that drive both HFpEF and CKD.

Summary

In this review, we will discuss recent clinical research focusing on HFpEF, CKD, and comorbidities including hypertension and diabetes mellitus. We will review strategies for volume management and novel therapeutic approaches with new classes of drugs, including sodium-glucose cotransporters and angiotensin receptor/neprilysin inhibitors, which may work through targeting of both the heart and the kidney. Lastly, we emphasize why focusing on the alleviation of factors provoking renal injury and slowing the progression of renal dysfunction may provide the most therapeutic benefit in patients who have been diagnosed with HFpEF.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, University of Utah School of Medicine, 30 North, 1900 East, Rm 4A100 SOM, Salt Lake City, UT, 84132, USA

    Kevin S. Shah & James C. Fang

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  1. Kevin S. Shah
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  2. James C. Fang
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Correspondence to James C. Fang.

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Conflict of Interest

Dr James Fang served on the Steering Committee for the EVALUATE-HF Trial and as a co-lead investigator for the DELIVER trial.

Dr Shah has no conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Mechanisms of Hypertension and Target-Organ Damage

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Shah, K.S., Fang, J.C. Is Heart Failure with Preserved Ejection Fraction a Kidney Disorder?. Curr Hypertens Rep 21, 86 (2019). https://doi.org/10.1007/s11906-019-0993-0

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  • DOI: https://doi.org/10.1007/s11906-019-0993-0

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