Diabetes and chronic kidney disease (CKD) are important comorbidities in patients with heart failure (HF) that can complicate the clinical management and have major implications for morbidity and mortality. In addition, the presence of these comorbidities, particularly advanced CKD, is a limitation for the implementation of guideline-directed therapies in patients with HF with reduced ejection fraction (HFrEF). Though clinical trials in patients with HFrEF trials included varying percentages of patients with diabetes and/or CKD, patients with advanced CKD have been excluded in most HF studies. Thus, management recommendations for these patients often have to be extrapolated from subgroup analyses. This article summarizes pathophysiological aspects of the interaction of HFrEF, CKD, and diabetes and addresses clinical aspects for the screening of these comorbidities. Moreover, current treatment options for patients with HFrEF and CKD and/or diabetes are discussed and novel strategies such as the use of the selective mineralocorticoid receptor antagonist Finerenone are addressed.
Competing Interests: Conflicts of interest: N.M. has received support for clinical trial leadership from Boehringer Ingelheim, Novo Nordisk; served as a consultant to Bayer, Boehringer Ingelheim, Merck, Novo Nordisk, AstraZeneca, BMS; received grant support from Boehringer Ingelheim, Merck, Novo Nordisk; and served as a speaker for Bayer, Boehringer Ingelheim, Merck, Novo Nordisk, Lilly, BMS, and AstraZeneca. R.A. has received support for clinical trial leadership from Bayer, Akebia, Vifor, and Diamedica; served as a consultant to Bayer, Akebia, Vifor, Diamedica, and Boehringer Ingelheim; served on data safety monitoring boards for Chinook and Vertex; received royalties from UpToDate; served as editor for Nephrology Dialysis Transplantation and American Journal of Nephrology; and received grant support from National Heart Lung and Blood Institute and United States Veterans Administration. S.J.G. has received research support from the Duke University Department of Medicine Chair’s Research Award, American Heart Association, National Heart Lung and Blood Institute, Amgen, AstraZeneca, Bristol Myers Squibb, Cytokinetics, Merck, Novartis, Pfizer, and Sanofi; has served on advisory boards for Amgen, AstraZeneca, Bristol Myers Squibb, and Cytokinetics, Roche Diagnostics, and Sanofi; has received speaker fees from Boehringer Ingelheim; and serves as a consultant for Amgen, Bayer, Boehringer Ingelheim/Eli Lilly, Bristol Myers Squibb, Merck, PhamaIN, Roche Diagnostics, Sanofi, Tricog Health, Urovant Pharmaceuticals, and Vifor. A.Y.Y.C. has received speaker and/or consulting fees from Abbott, Astra Zeneca, Bayer, Bausch, Boehringer Ingelheim, Dexcom, Eli Lilly, Insulet, HLS Therapeutics, Janssen, Medtronic, Merck, Novo Nordisk, Pfizer, Sanofi, Takeda; has participated in clinical trials from Applied Therapeutics and Sanofi. H.D. received speaker/or consulting fees from Astra Zenica, Pfizer, Bayer Sanofi, and Novartis.
(© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.)