Table 1.

A three-step road map for improving the outcomes of patients with advanced CKD and HF

1. Improve our understanding of the epidemiology, pathophysiology, diagnosis and risk stratification of HF in patients with advanced CKD and particularly in those on different modalities of KRT

a. Adapt the definitions of HF and HFH to patients with advanced CKD

b. Validate traditional and potentially non-traditional cardiac biomarkers in patients with advanced CKD

c. Validate and/or develop methods for risk stratification that allow the enrichment of clinical trials with patients with advanced CKD at higher risk for HF-related events

2. Design and conduct adequately powered clinical trials to address questions related to the optimization of prevention and treatment strategies specific to patients with advanced CKD

a. Use adapted definition of HF and HFH

b. Use validated methods and risk stratification methods to enrich the high HF-risk patient and adapt the trial population to the mechanism of action of the intervention: aim at precision therapy

c. Careful adverse event monitoring

d. Include patient-oriented outcomes and adapt outcomes to the advanced CKD reality

e. Implement virtual remote healthcare services that facilitate compliance and patient retention

3. Extend the nephrology–cardiology collaboration into the development of consensus documents and clinical guidelines that facilitate the rapid uptake and implementation of therapeutic advances.