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Background: Heart failure with preserved ejection fraction (HFpEF) often coexists with chronic kidney disease (CKD). Exercise intolerance is a major determinant of quality of life and morbidity in both scenarios. We aimed to evaluate the associations between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and carbohydrate antigen 125 (CA125) with maximal aerobic capacity (peak VO 2 ) in ambulatory HFpEF and whether these associations were influenced by kidney function., Methods: This single-centre study prospectively enrolled 133 patients with HFpEF who performed maximal cardiopulmonary exercise testing. Patients were stratified across estimated glomerular filtration rate (eGFR) categories (<60 ml/min/1.73 m 2 versus ≥60 ml/min/1.73 m 2 )., Results: The mean age of the sample was 73.2 ± 10.5 years and 56.4% were female. The median of peak VO 2 was 11.0 ml/kg/min (interquartile range 9.0-13.0). A total of 67 (50.4%) patients had an eGFR <60 ml/min/1.73 m 2 . Those patients had higher levels of NT-proBNP and lower peak VO 2 , without differences in CA125. In the whole sample, NT-proBNP and CA125 were inversely correlated with peak VO 2 ( r  = -0.43, P  < .001 and r  = -0.22, P  = .010, respectively). After multivariate analysis, we found a differential association between NT-proBNP and peak VO 2 across eGFR strata ( P for interaction = .045). In patients with an eGFR ≥60 ml/min/1.73 m 2 , higher NT-proBNP identified patients with poorer maximal functional capacity. In individuals with eGFR <60 ml/min/1.73 m 2 , NT-proBNP was not significantly associated with peak VO 2 [β = 0.02 (95% confidence interval -0.19-0.23), P  = .834]. Higher CA125 was linear and significantly associated with worse functional capacity without evidence of heterogeneity across eGFR strata ( P for interaction = .620)., Conclusions: In patients with stable HFpEF, NT-proBNP was not associated with maximal functional capacity when CKD was present. CA125 emerged as a useful biomarker for estimating effort intolerance in HFpEF irrespective of the presence of CKD., Competing Interests: J.N. is a member of the CKJ editorial board. The other authors declare no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)

Background: Albuminuria could potentially emerge as a novel marker of congestion in acute heart failure. However, the current evidence linking albuminuria and congestion in patients with congestive heart failure (CHF) remains somewhat scarce. This study aimed to evaluate the prevalence of albuminuria in a cohort of patients with CHF, identify the independent factors associated with albuminuria and analyse the correlation with different congestion parameters., Methods: This is a subanalysis of the Spanish Cardiorenal Registry, in which we enrolled 864 outpatients with heart failure and a value of urinary albumin:creatinine ratio (UACR) at the first visit., Results: The median age was 74 years, 549 (63.5%) were male and 438 (50.7%) had a reduced left ventricular ejection fraction. A total of 350 patients (40.5%) had albuminuria. Among these patients, 386 (33.1%) had a UACR of 30-300 mg/g and 64 (7.4%) had a UACR >300 mg/g. In order of importance, the independent variables associated with higher UACR were estimated glomerular filtration rate determined by the Chronic Kidney Disease Epidemiology Collaboration equation ( R 2  = 57.6%), systolic blood pressure ( R 2  = 21.1%), previous furosemide equivalent dose (FED; R 2  = 7.5%), antigen carbohydrate 125 (CA125; R 2  = 6.1%), diabetes mellitus ( R 2  = 5.6%) and oedema ( R 2  = 1.9%). The combined influence of oedema, elevated CA125 levels and the FED accounted for 15.5% of the model's variability., Conclusions: In patients with chronic stable heart failure, the prevalence of albuminuria is high. The risk factors of albuminuria in this population are chronic kidney disease and hypertension. Congestion parameters are also associated with increased albuminuria., Competing Interests: M.J.S. and J.N. are members of the CKJ editorial board., (© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)

Worsening kidney function (WKF) is common in patients with acute heart failure (AHF) syndromes. Although WKF has traditionally been associated with worse outcomes on a population level, serum creatinine concentrations vary greatly during episodes of worsening heart failure, with substantial individual heterogeneity in terms of their clinical meaning. Consequently, interpreting such changes within the appropriate clinical context is essential to unravel the pathophysiology of kidney function changes and appropriately interpret their clinical meaning. This article aims to provide a critical overview of WKF in AHF, aiming to provide physicians with some tips and tricks to appropriately interpret kidney function changes in the context of AHF., Competing Interests: J.N. is member of the CKJ editorial board. The other authors declare no conflicts of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.)

The population with concomitant heart and kidney disease (often termed 'cardiorenal' disease) is expected to grow, significantly impacting public health and healthcare utilization. Moreover, the cardiorenal nexus encompasses a bidirectional relationship that worsens prognosis and may complicate pharmacological management in often elderly and frail patients. Therefore, a more cohesive multidisciplinary team approach aiming to provide holistic, coordinated and specialized care would be a positive shift towards improving patient outcomes and optimizing healthcare resources. This article aims to define the organizational aspects and key elements for setting up a multidisciplinary cardiorenal clinical program as a potential healthcare model adapted to the particular characteristics of patients with cardiorenal disease., Competing Interests: C.R. reports payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Asahi, Baxter, Biomerieux, Jafron, Medica and GE and participation on data safety monitoring boards/advisory boards for Baxter, Jafron and Biomerieux. D.B. reports research grants from Kidney Research UK and AstraZeneca ESR, payment for lecture fees from AstraZeneca and Vifor Pharma and participation on an advisory board for Bayer. J.L.G. reports consulting fees from Bayer, AstraZeneca and Boehringer Ingelheim; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Bayer, AstraZeneca, Novo Nordisk and Boehringer Ingelheim and support for attending meetings and/or travel from Vifor Pharma. B.Q. reports consulting fees, participation on data safety monitoring boards or advisory boards, support for attending meetings and/or travel and payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Novartis, AstraZeneca, Sandoz, Laboratorios Bial, Esteve, Sanofi-Genzyme and Otsuka and is the secretary of the Spanish Society of Nephrology. J.D. reports consulting fees and payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from AstraZeneca, Bayer and Vifor Pharma and consulting fees from GlaxoSmithKline. M.J.S. reports grants or contracts from Instituto Carlos III, Marató TV3 and Boehringer Ingelheim; honoraria for lectures from Novo Nordisk, Jansen, Boehringer Ingelheim, Mundipharma, AstraZeneca, Ingelheim Lilly, Vifor Pharma, ICU Medical, Fresenius and Travere Therapeutics; support for attending meetings and/or travel from Travere and participation on advisory boards for Novo Nordisk, Jansen, Boehringer Ingelheim, Mundipharma, AstraZeneca, Ingelheim Lilly, Vifor Pharma, ICU Medical, Fresenius, Travere Therapeutics and GE Healthcare. M.J.S. and J.N. are members of the CKJ editorial board. All other authors declare no competing interests., (© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.)

Point-of-Care Ultrasonography (PoCUS) aims to include a fifth pillar (insonation) in the classical physical examination in order to obtain images to answer specific questions by the clinician at the patient's bedside, allowing rapid identification of structural or functional abnormalities, enabling more accurate volume assessment and supporting diagnosis, as well as guiding procedures. In recent years, PoCUS has started becoming a valuable tool in day-to-day clinical practice, adopted by healthcare professionals from various medical specialties, never replacing physical examination but improving patient and medical care and experience. Renal patients represent a wide range of diseases, which lends PoCUS a special role as a valuable tool in different scenarios, not only for volume-related information but also for the assessment of a wide range of acute and chronic conditions, enhancing the sensitivity of conventional physical examination in nephrology. PoCUS in the hands of a nephrologist is a precision medicine tool., (© The Author(s) 2022. Published by Oxford University Press on behalf of the ERA.)

Despite the high prevalence of chronic kidney disease (CKD) and its high cardiovascular risk, patients with CKD, especially those with advanced CKD (stages 4-5 and patients on kidney replacement therapy), are excluded from most cardiovascular clinical trials. It is particularly relevant in patients with advanced CKD and heart failure (HF) who have been underrepresented in many pivotal randomized trials that have modified the management of HF. For this reason, there is little or no direct evidence for HF therapies in patients with advanced CKD and treatment is extrapolated from patients without CKD or patients with earlier CKD stages. The major consequence of the lack of direct evidence is the under-prescription of HF drugs to this patient population. As patients with advanced CKD and HF represent probably the highest cardiovascular risk population, the exclusion of these patients from HF trials is a serious deontological fault that must be solved. There is an urgent need to generate evidence on how to treat HF in patients with advanced CKD. This article briefly reviews the management challenges posed by HF in patients with CKD and proposes a road map to address them., (© The Author(s) 2021. Published by Oxford University Press on behalf of the ERA.)