Early chronic kidney disease affects 10-15% of adults worldwide and is associated with subclinical cardiac abnormalities (pre-heart failure) that may be mitigated by therapies like SGLT2 inhibitors.
This review highlights the importance of recognizing and managing pre-heart failure in patients with early chronic kidney disease using modern cardiorenal therapies.
Abstract Chronic kidney disease (CKD), defined per the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines by persistent (≥3 months) abnormalities of kidney structure or function, including reduced estimated glomerular filtration rate (eGFR) and/or albuminuria, affects 10%–15% of adults worldwide and is a powerful, independent risk factor for cardiovascular diseases, including heart failure (HF). In CKD (stages G1–G3), particularly when accompanied by albuminuria (KDIGO stages A2–A3), even mild reductions in eGFR are associated with subclinical cardiac abnormalities—left ventricular hypertrophy, concentric remodelling, LV diastolic dysfunction, HF with preserved ejection fraction, and arrhythmias. Many CKD patients meet criteria for Stage B HF within the contemporary ‘pre-HF’ framework, based on structural and functional cardiac alterations and elevated biomarkers in the absence of symptoms. Detection is here challenging, as symptoms are non-specific and circulating biomarkers are confounded by reduced renal clearance. Echocardiography, including speckle-tracking techniques and emerging indices, and cardiac magnetic resonance imaging with tissue characterization and strain analysis are sensitive tools for early diagnosis and risk stratification, but routine screening is not currently recommended in asymptomatic CKD. This condition may be mitigated by aggressive control of traditional and CKD-specific risk factors, and therapies with proven cardiorenal benefits—SGLT2 inhibitors, finerenone, diuretics, renin–angiotensin system blockers, and selected GLP-1 receptor agonists—guide HF prevention. Future research should test cost-effective early diagnostic strategies, clarify the role of imaging and biomarkers in guiding therapy, and exploit multiomics and artificial intelligence to unravel mechanistic heterogeneity and enable personalized prevention of HF in early CKD.
“Chronic kidney disease is a significant comorbidity that is often under addressed despite its strong association with heart failure. Even a mildly reduced GFR can portend an increased risk. The statement emphasizes the importance of recognizing CKD as a key target for heart failure prevention, especially with the advent of kidney-protective therapies.”
Zoccali et al. (2026) conducted a review in Chronic kidney disease and pre-heart failure. Early chronic kidney disease affects 10-15% of adults worldwide and is associated with subclinical cardiac abnormalities (pre-heart failure) that may be mitigated by therapies like SGLT2 inhibitors.