Multidisciplinary approach to patients with heart failure and kidney disease: preliminary experience of an integrated cardiorenal unit

Background Cardiorenal programs have emerged to improve the management of cardiorenal disease (CRD). Evidence about the benefits of these programs is still scarce. This work aims to evaluate the performance of a novel cardiorenal program and describe the clinical profile and outcomes of patients with CRD. Methods We conducted a retrospective observational study of patients with CRD attended in a cardiorenal unit (CRU) from February 2021 to February 2022. Demographics and laboratory tests were collected and events (all-cause death and cardiovascular hospitalizations) were evaluated. Optimization of comorbidities and protective therapies was also assessed. Results Eighty-two patients were included, with a mean age of 76.8 years [standard deviation (SD) 8.5] and 72% were men. A total of 58.5% (n = 47) had left ventricular ejection fraction <50%. The mean follow-up was 11 months (SD 4.0). Almost 54% of the patients (n = 44) required hospitalization, 30.5% for heart failure (HF) decompensation. Total hospitalizations significantly decreased after CRU inclusion: 0.70 versus 0.45 admissions/year (P < .02). Global mortality was 17.1% (n = 14). The percentage of patients with HF with reduced ejection fraction on quadruple therapy increased by 20%, and up to 60% of the patients were on three drugs. A total of 39% of the patients with HF and preserved ejection fraction started treatment with sodium-glucose co-transporter inhibitors. Hyperkalaemia required the use of potassium binders in 12.2% of the patients and treatment of secondary hyperparathyroidism was started in 42.7% and renal anaemia in 23.2%. Renal replacement therapy was initiated in 10% of the patients (n = 8). Conclusion CRD confers a considerable risk of adverse outcomes. Cardiorenal programs may improve cardiorenal syndrome management by optimizing therapies, treating comorbidities and reducing hospitalizations. Lay Summary This article describes the structure and the initial achievements of a recently created multidisciplinary unit focused on the management of cardiorenal patients with a high degree of complexity. Eighty-two patients were included in this analysis, with a mean follow-up of 11 months. Low estimated glomerular filtration rate, diuretic resistance or inexplicable worsening of renal failure were the main reasons for referral. This unit's main achievements were optimizing cardio- and nephroprotective therapies, managing diuretic resistance, treating chronic kidney disease comorbidities and planification of renal replacement therapy when indicated. This combined approach has led to significant benefits in terms of hospitalization rates and stability in renal function, with a low rate of patients initiating dialysis.