What to do with foundation therapies for heart failure for patients with end-stage kidney disease on haemodialysis

• DOI: 10.12968/hmed.2023.0452
• Publication Date: 2024-05-13T14:45:20Z
• Authors: Sherna F Adenwalla; Katherine L Hull; Matthew PM Graham...
• Keywords: Cardiorenal syndrome

There is a significant burden of cardiovascular disease morbidity and mortality in the end-stage kidney population, driven by traditional non-traditional risk factors. Despite its prevalence, heart failure difficult to diagnose dialysis population due overlapping clinical presentations, limitations investigations, impact on cardiorenal axis. ‘Foundation therapies’ are key medications which improve patient outcomes with reduced ejection fraction include beta-blockers, renin-angiotensin-aldosterone system inhibitors sodium-glucose cotransporter-2 inhibitors. They underutilised exclusion chronic patients from major trials legitimate concerns e.g. hyperkalaemia, intradialytic hypotension residual function preservation. A coordinated multidisciplinary approach can guide appropriate diagnostic considerations (biomarkers interpretation, imaging, addressing unique complications disease), optimise management (prescription length, frequency ultrafiltration targets) when at euvolaemia facilitate stepwise introduction foundation therapies.