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.
GLP-1RAs benefit both HF and CKD patientsKDIGO consensus identifies GLP-1 receptor agonists alongside SGLT2 inhibitors and finerenone as therapies with dual cardio-renal benefits
What the researchers 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.
Why it 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.
How the study worked
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.
What this study cannot 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.
How to read the evidence
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.
When this study was published
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.
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.
Questions still open
- 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?
Common questions
Why are GLP-1 receptor agonists relevant to heart failure and kidney disease?
Should heart failure medications be stopped if kidney function drops slightly?
Read the original research
Kidney disease and heart failure: recent advances and current challenges: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.
Kidney international
Citation
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