Assessment and management of heart failure in patients with chronic kidney disease.

Heart failure (HF) and chronic kidney disease (CKD) are two pathological conditions with a high prevalence in the general population. When they coexist in the same patient, a strict interplay between them is observed, such that patients affected require a clinical multidisciplinary and personalized management. The diagnosis of HF and CKD relies on signs and symptoms of the patient but several additional tools, such as blood-based biomarkers and imaging techniques, are needed to clarify and discriminate the main characteristics of these diseases. Improved survival due to new recommended drugs in HF has increasingly challenged physicians to manage patients with multiple diseases, especially in case of CKD. However, the safe administration of these drugs in patients with HF and CKD is often challenging. Knowing up to which values ​​of creatinine or renal clearance each drug can be administered is fundamental. With this review we sought to give an insight on this sizable and complex topic, in order to get clearer ideas and a more precise reference about the diagnostic assessment and therapeutic management of HF and CKD.

Comprehensive geriatric assessment in the hemodialysis elderly population.

The aim of this study was to assess the usefulness of a Multidimensional Prognostic Index (MPI) based on a Comprehensive Geriatric Assessment (CGA) in defining comorbidity and the need for a multidisciplinary approach in older patients with end-stage renal disease. This was a cross-sectional study that included 162 patients, 103 aged 65 and over with a diagnosis of end-stage renal disease and ongoing chronic hemodialysis treatment. Results were compared with a group of 250 geriatric patients without renal impairment. A standardized CGA that included information on clinical, cognitive, functional and nutritional aspects, as well as comorbidity, medications and social support network, was used to calculate MPI. Among the dialysis patients, the vast majority showed a moderate (58.3%) or high risk score (19.4%). MPI score was clearly correlated with Charlson index (P = .001) both in the global population and the dialysis patients aged over 65. Compared to geriatric patients without renal failure, all MPI score domains were more compromised in the dialysis population. These preliminary findings strongly suggest that MPI may be very useful to assess the clinical picture of older patients undergoing renal replacement therapy (RRT). Its use in the dialysis population under 65 needs to be investigated.