Managing Heart Failure and Kidney Disease Together: KDIGO Expert Consensus on Emerging Therapies Including GLP-1 Agonists
A KDIGO expert conference concluded that GLP-1 receptor agonists and other emerging therapies benefit patients with coexisting heart failure and chronic kidney disease, while emphasizing the need for better diagnostic criteria and more integrated treatment approaches.
Quick Facts
What This Study Found
The conference identified several key conclusions for managing coexisting heart failure (HF) and chronic kidney disease (CKD):
SGLT2 inhibitors, RAAS inhibitors, finerenone, and GLP-1 receptor agonists all show benefits in patients with both HF and CKD, though evidence in advanced CKD remains limited. Natriuretic peptide biomarkers require careful interpretation in CKD patients, and CKD-specific diagnostic thresholds for HF are needed.
Critically, small declines in kidney function after initiating guideline-directed HF therapies are generally hemodynamic in nature and not associated with poor outcomes — meaning they should not trigger treatment discontinuation. The conference called for more integrated cardio-renal management approaches and clinical trials that include relevant kidney endpoints.
Key Numbers
How They Did This
This paper summarizes conclusions from a KDIGO (Kidney Disease: Improving Global Outcomes) Controversies Conference held in March 2024. The conference brought together international experts in nephrology, cardiology, and related fields to discuss evidence, identify controversies, and reach consensus on key issues in managing the intersection of kidney disease and heart failure.
Why This Research Matters
Heart failure and kidney disease each affect millions of people, and when they occur together — which is very common — outcomes are dramatically worse. Patients often fall between cardiology and nephrology, receiving suboptimal care for one condition while being treated for the other. This KDIGO consensus highlights that peptide-based therapies like GLP-1 receptor agonists and natriuretic peptide biomarkers are increasingly central to managing these complex patients, and calls for the integrated approach these patients need.
The Bigger Picture
This conference reflects a growing recognition that heart and kidney diseases cannot be treated in silos. The inclusion of GLP-1 receptor agonists alongside established cardio-renal therapies marks the expanding role of peptide-based drugs in managing multi-organ disease. As GLP-1RAs demonstrate cardiovascular and potentially renal benefits beyond their metabolic effects, they're becoming part of the treatment toolkit for some of the most complex and common patient populations in medicine.
What This Study Doesn't Tell Us
This is a consensus conference report, not a systematic review or meta-analysis. The conclusions represent expert opinion synthesized from available evidence, which may be limited for some subgroups (particularly advanced CKD). Evidence for newer agents like GLP-1RAs in combined HF-CKD populations is still emerging. The conference format may not capture the full spectrum of debate on controversial topics.
Questions This Raises
- ?What are the optimal natriuretic peptide cutoff values for diagnosing heart failure in patients with varying stages of CKD?
- ?How effective are GLP-1 receptor agonists specifically in patients with advanced CKD (stages 4-5) and heart failure?
- ?Should cardiology and nephrology teams adopt standardized shared-care protocols for patients with both conditions?
Trust & Context
- Key Stat:
- GLP-1RAs benefit both HF and CKD patients KDIGO consensus identifies GLP-1 receptor agonists alongside SGLT2 inhibitors and finerenone as therapies with dual cardio-renal benefits
- Evidence Grade:
- This is an expert consensus statement from KDIGO, a leading guideline organization. While it synthesizes clinical trial evidence, it represents expert interpretation and opinion rather than new primary data. The strength of evidence varies by topic — strong for SGLT2 inhibitors, still emerging for GLP-1RAs in advanced CKD.
- Study Age:
- Published in 2025 based on a March 2024 conference, this represents very current expert consensus on cardio-renal management. The rapid evolution of evidence in this field means recommendations may be updated as new trial data emerge.
- Original Title:
- Kidney disease and heart failure: recent advances and current challenges: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.
- Published In:
- Kidney international (2028)
- Authors:
- Lam, Carolyn S P(3), Bozkurt, Biykem(3), Cherney, David Z I(7), Ezekowitz, Justin A, Jardine, Meg J, Khan, Sadiya S, Madero, Magdalena, Sarnak, Mark J, Ter Maaten, Jozine M, Cheung, Michael, King, Jennifer M, Grams, Morgan E, Jadoul, Michel, Bansal, Nisha
- Database ID:
- RPEP-16637
Evidence Hierarchy
Frequently Asked Questions
Why are GLP-1 receptor agonists relevant to heart failure and kidney disease?
Originally developed for diabetes, GLP-1 receptor agonists (like semaglutide and liraglutide) have been shown in clinical trials to reduce cardiovascular events including heart failure hospitalizations. Emerging evidence also suggests potential kidney-protective effects. Since heart failure and kidney disease often occur together, therapies that benefit both organs are particularly valuable for these complex patients.
Should heart failure medications be stopped if kidney function drops slightly?
Generally no, according to this expert consensus. Small declines in kidney function after starting guideline-recommended heart failure therapies are typically hemodynamic — meaning they reflect changes in blood flow rather than actual kidney damage. These temporary dips are not associated with worse outcomes, so stopping effective heart failure medications would deprive patients of important benefits.
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Cite This Study
https://rethinkpeptides.com/research/RPEP-16637APA
Lam, Carolyn S P; Bozkurt, Biykem; Cherney, David Z I; Ezekowitz, Justin A; Jardine, Meg J; Khan, Sadiya S; Madero, Magdalena; Sarnak, Mark J; Ter Maaten, Jozine M; Cheung, Michael; King, Jennifer M; Grams, Morgan E; Jadoul, Michel; Bansal, Nisha. (2028). Kidney disease and heart failure: recent advances and current challenges: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.. Kidney international. https://doi.org/10.1016/j.kint.2025.10.011
MLA
Lam, Carolyn S P, et al. "Kidney disease and heart failure: recent advances and current challenges: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.." Kidney international, 2028. https://doi.org/10.1016/j.kint.2025.10.011
RethinkPeptides
RethinkPeptides Research Database. "Kidney disease and heart failure: recent advances and curren..." RPEP-16637. Retrieved from https://rethinkpeptides.com/research/lam-2028-kidney-disease-and-heart
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Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkPeptides research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.