Optimising Access to Care for Patients with Heart and Kidney Diseases: A World Heart Federation and International Society of Nephrology White Paper

The clinical impact of diabetes medications, including sodium-glucose cotransporter-2 inhibitors, non-steroidal mineralocorticoid receptor antagonists, and glucagon-like peptide 1 receptor agonists on cardiovascular and kidney disease outcomes has focused attention on the interrelatedness of kidney and heart health, both within and outside the context of diabetes. These conditions often co-exist, causing frequent hospitalizations and premature deaths. Herein, we provide an updated, comprehensive state-of-the-art review, summarizing the linkages between heart disease and kidney disease, the mechanisms connecting these conditions, common risk factors, management, implications for health systems, and the impact on patients, particularly in low-resource settings. As experts representing the World Heart Federation and the International Society of Nephrology, we highlight areas of opportunity and provide recommendations on improving access to care for the growing numbers of patients with heart and kidney diseases, with a focus on lowand middle-income countries.