The synergistic treatment of heart and kidney disease

BACKGROUND: The incidence and prevalence of both cardiac and renal disease in Germany are steadily rising. Heart disease is the most common cause of death, especially among people with chronic kidney disease. Impaired kidney function increases the risk of cardiovascular events, and vice versa. METHODS: This narrative review is based on pertinent publications retrieved by a literature search up to the year 2025, with particular attention to the guidelines of the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF) and the European Society of Cardiology (ESC). Supplementary searches were conducted on individual aspects of the epidemiology, diagnosis, and treatment of heart and kidney disease. RESULTS: The heart and the kidneys are closely pathophysiologically linked. Both can be damaged by shared vascular risk factors, including diabetes mellitus, arterial hypertension, and chronic inflammation. These shared mechanisms give rise to a continuum of diseases. Multiple RCTs have shown in recent years that the morbidity and mortality of patients with heart and kidney diseases can be significantly lowered by treatment not only with ACE inhibitors, but also with sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide 1 receptor agonists (GLP1-RA), and nonsteroidal mineralocorticoid receptor antagonists (nsMRA). Absolute risk reductions in the range of 1.8% to 6.7% have been found to be achievable for most of the combined endpoints studied, depending on the particular active substance used. CONCLUSION: Heart and kidney diseases often arise together and can be treated with new pharmacotherapeutic strategies. Open questions remain concerning the potential synergistic effects of the drugs mentioned above, the suitable management of polypharmacy, and the enabling of cost-effective care.