When Dr. Tony Das, an interventional cardiologist, evaluates his patients with heart disease, he is acutely aware that he must also look for signs of kidney disease. For the past five years, his Dallas-based cardiology practice has partnered with a nephrologist in their clinic, which ensures a more coordinated care approach for patients with these related illnesses. Now every kidney patient is routinely screened for heart disease and every heart patient is carefully monitored for kidney function.
“When you come into see your doctor, if you have multiple overlapping complaints then it’s good for someone to be able to assess the whole patient in a more productive and holistic way,“ says Dr. Das, who runs a catherization lab in partnership with National Cardiovascular Partners (NCP), part of Fresenius Medical Care North America. “Many patients we treat at NCP often have cardiovascular disease and lower extremity arterial disease and are frequently patients with renal dysfunction as well.”
The kidneys and the heart have a tight relationship. The two organs usually work in harmony as the heart pumps blood to the kidneys which removes toxins from the body. But when one gets sick, the other organ suffers as well. A growing body of research has documented the way kidney disease can trigger or worsen heart disease and how heart disease can destroy the kidneys. High blood pressure and diabetes are both top risk factors for kidney and heart disease, another clear link between these two organs.
Many patients with chronic kidney disease (CKD), for example, will die of heart failure before they even reach end stage renal disease (ESRD) and need dialysis. According to the USRDS, more than half of deaths in patients with ESRD are attributable to underlying cardiovascular disease. That’s why early intervention and monitoring is so crucial to improving outcomes for patients with either or both diseases.
“If the heart is weakened by congestive heart failure and not beating adequately and there is not enough blood flow from the heart to the rest of the organs, you start to see a reduction of kidney flow and then the kidney function worsens,” explains Dr. Das.
At the same time, as kidney disease progresses, the kidneys are increasingly unable to remove toxins from the body, which results in an imbalance of electrolytes such as sodium and potassium. That can lead to heart arrhythmias and serious risk for cardiac arrest. Dr. Das says it’s a “cycle” that is often challenging to stop.
In response to increasing awareness of this tight relationship, cardiology practices across the country are beginning to take a more cardiorenal approach to their medical practice and evaluation of patients. But Dr. Das believes that coordination could improve even more between cardiologists and nephrologists.
“We have always known about this relationship, but people are actually talking about cardiorenal medicine now as a real concept and addressing it as a combined operational assessment,” says Dr. Das.
For the first time in 2017, Fresenius Medical Care North America presented a Cardiorenal University with an interactive physician education program. This included cross-training labs and workshops in cardiology and nephrology aimed at broadening knowledge and improving outcomes for patients facing the co-morbidities of chronic kidney disease and cardiovascular disease.
This sharing of information between doctors treating kidney and heart disease will continue to be a focus for Fresenius Medical Care North America as it expands integrated and value based care models. Many health care leaders see this approach as critical to improving patient outcomes and lowering costs to the health care system.