Tarek Abbas: Patients With Advanced Cardiovascular Kidney Metabolic Syndrome Have High Risk of Cardiovascular Complications
Tarek Abbas, Senior Consultant of Nephrology and Renal Transplantation at Mansoura University School of Medicine, shared a post on LinkedIn:
“What to do with key cardiovascular drugs when kidney function worsens?
Title: What to do with key cardiovascular drugs when kidney function worsens?
Authors: Karin Bergen, Jonas Spaak
Read full study here.
Clinical Kidney Journal, sfaf354,
Published: 21 November 2025
Patients with advanced cardiovascular kidney metabolic syndrome have high risk of cardiovascular complications.
Guideline-directed medical therapies (GDMT) are critical for mitigating cardiovascular risk and improving prognosis.
Patients with more advanced kidney disease have frequently been excluded from the foundational cardiovascular outcome trials, leaving clinicians with a paucity of evidence with regards to the cardiovascular benefits and potential risks involved in initiating or maintaining GDMT for cardiovascular diseases in patients with chronic kidney disease stages 4 and 5.
Systematic underutilization of GDMT among patients with advanced chronic kidney disease (CKD) is caused by a combination of clinical inertia and a legitimate fear of potential side-effects such as hyperkalemia and rises in creatinine, which necessitate repeat lab monitoring, dose adjustment and additional potassium lowering treatment.
In this clinical review, the authors summarized the accumulating evidence of using key cardiovascular drugs among patients with advanced CKD, (with an emphasis on GDMT in patients with heart failure), and outlined the treatment approach used in integrated heart-nephrology-diabetes clinic.
Since the evidence is not clear and patients are older, frailer and have more multimorbidity than those included in clinical trials, sound clinical judgment, individual patient tolerability as well as shared decision making are key.
Continuous alignment treatment goals with patient preferences across different phases of life and adjusting GDMT in the face of increasing frailty.”
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