The cardiorenal continuum: a focus on iron deficiency, arrhythmia

Abstract

Heart failure remains a leading cause of hospitalisation in the developed world. Comorbidities such as iron deficiency and chronic kidney disease (CKD) pose management challenges and have been proven to have prognostic impact. The link between cardiac and renal disease is complex and is now understood to begin before abnormalities in either system become manifest. This gradual transition from coexistence of risk factors to target organ damage and death is often referred to as the cardiorenal continuum. When cardiac and renal dysfunction co-exist, further challenges arise due to the high burden of cardiovascular risk factors that characterise these populations and the lack of a robust evidence base specific for these patients. Management can therefore be biased and sub optimal.

This thesis focuses on two major comorbidities of heart failure- iron deficiency and chronic kidney disease, with the former being a common comorbidity to both pathologies. The first part of this thesis aims to understand the role of iron deficiency in acute heart failure, its prevalence and its potential links to inflammation and renal dysfunction. The second part of this thesis focuses on cardiorenal disease and aims to define arrhythmic burdens and incidence of sudden cardiac death in end stage kidney disease patients. This thesis also aims to establish the safety and feasibility of using evidence-based therapies in the presence of CVD and renal dysfunction and compares prescribing practices, complication rates and outcomes in those with and without significant CKD.

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ORCID for Mark Hanson: orcid.org/0000-0002-6907-613X

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