Janani Rangaswami, MD: Heart Failure in End Stage Kidney Disease Patients

How do doctors reduce the costly and time-consuming burden of heart failure in patients already suffering from end stage kidney disease?

Janani Rangaswami, MD, a nephrologist at the Einstein Medical Center Philadelphia explained in an interview with MD Magazine® during the Heart Failure Society of America (HFSA) 2019 Scientific Sessions in Philadelphia, PA, that this burden can be reduced by increasing the frequency of dialysis treatment, while also pushing those treatments to occur more in the home.

However, achieving this goal will take a patient education campaign, as well as collaborative efforts between cardiologists and nephrologists.

MD Mag: On the HFSA presentation about heart failure in end stage kidney disease patients.

Rangaswami: Today, my symposium just concluded and our symposium was on the burden of heart failure and patients with end-stage kidney disease. We talked in detail about the pathophysiology of the problem and some of the diagnostic dilemmas in making the diagnosis of heart failure in patients with end stage kidney disease and what some of the therapeutic legalities that are available in helping reduce the burden of heart failure.

MD Mag: On the importance of her presentation at HFSA.

Rangaswami: The burden of heart failure is clearly underestimated in the dialysis population. Unfortunately, there is a perception that there is not a lot we can offer these patients. Dialysis patients in general tend to have worse outcomes, they tend to have premature death, they have a huge burden of cardiovascular disease and heart failure, but if carefully done there are targets to treat that can clearly reduce the burden for heart failure.

We spent a fair amount of time talking about the benefits of prolonged dialysis, frequent dialysis, and therapies that are based at home as opposed to the typical 3 times a week dialysis that most clinicians are used to seeing. There are major benefits—reduction of hospitalization for heart failure, a better quality of life—for patients who undergo more dialysis and I really think that was 1 of the take home points of our session.

In terms of the standard medications, when you look at the data in heart failure with kidney disease, the data is not robust but there is still scope to optimize these medications. And again, I think it rests upon the ability of a collaborative effort between cardiologists and nephrologists to achieve those goals.