CKD and Your Heart: How Chronic Kidney Disease Affects Cardiovascular Health

Chronic kidney disease (CKD) doesn’t just affect your kidneys. It changes how your heart and blood vessels function, too. Over time, CKD can significantly raise your risk of heart problems.

“The kidneys and heart are intricately related,” says Nisha Bansal, MD, a nephrologist and lead kidney-heart specialist at UW Medicine in Seattle. “Disease in one organ can often lead to disease in the other.”

Understanding that connection is one of the most important steps you can take to protect your long-term health.

• Cleaning the blood by removing extra fluid and waste
• Helping control blood pressure by removing salt and releasing enzymes that constrict blood vessels, affecting how hard your heart has to work
• Maintaining the balance of important body chemicals that affect heart rhythm, blood vessels, and circulation

Like teammates, when one organ struggles, the other often has to work harder, Dr. Mehdi says. “If the kidneys aren’t working well, fluid and toxins build up, putting additional strain on the heart,” he says. “If the heart isn’t pumping well, the kidneys may not get enough blood to function properly, and kidney function drops.”

Think of it as a vicious cycle, Mehdi says: “Metabolic problems damage blood vessels. That harms both the heart and kidneys. When the heart and kidneys weaken, they make blood pressure, fluid balance, and metabolism worse.”

Several changes that happen in CKD can directly increase cardiovascular risk.

Fluid Overload

Healthy kidneys remove excess water from your body. When they can’t, fluid builds up in the bloodstream and tissue.

High Blood Pressure and Hormonal Changes

Kidneys play a central role in controlling blood pressure. When they’re damaged, blood pressure often rises and becomes harder to manage.

“When the kidneys don’t function, patients develop hypertension (high blood pressure),” Dr. Bansal says. “The kidneys regulate hormones that lead to good vascular health. When that is disrupted, the resulting hypertension causes stress on the heart.”

High blood pressure can also damage the vessels and accelerate cholesterol plaque buildup in the arteries, called atherosclerosis, Mehdi says.

Mineral Imbalances

Kidneys maintain the right balance of minerals in your blood.

When the balance of calcium and phosphorus is off, the body can’t produce enough of a hormone that helps activate vitamin D, which you need to absorb calcium from your diet, Mehdi says.

“Then the active form of vitamin D drops, and that can lead to low blood calcium,” he says.

At the same time, phosphorus builds up the body, and the hormonal adjustments the body makes to restore the balance can cause significant issues, including bone disease and multiple cardiovascular complications, Mehdi says.

“Over time, these changes can cause calcium to deposit in blood vessels, making them stiff, almost like pipes,” he says.

The plaque that forms may also be distributed differently, making it harder to treat, Bansal says.

“Stiffer blood vessels increase blood pressure and raise the risk of heart attack and stroke,” she says.

Anemia

Anemia is common in people with CKD, especially in the more advanced stages of the disease. Your kidneys produce a hormone that signals the body to make red blood cells. But if your kidneys are damaged, you produce fewer red blood cells, which leads to anemia.

Because of the bodily changes that CKD causes, people with CKD face higher rates of several heart conditions:

• Left Ventricular Hypertrophy (LVH) “A large proportion of patients who have chronic kidney disease develop LVH,” Bansal says. This thickening of the heart’s main pumping chamber is considered an early, often silent step toward heart failure.
• Heart Failure Compared with people without CKD, those with kidney disease have a threefold higher risk of developing heart failure, Bansal says.
• Coronary Artery Disease CKD accelerates plaque buildup in the arteries that supply blood to the heart, increasing heart attack risk, Bansal says.
• Atrial Fibrillation (AFib) and Other Arrhythmias “As many as a quarter of patients with chronic kidney disease likely have atrial fibrillation,” Bansal says.

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   Mineral imbalances and fluid shifts can disrupt the heart’s electrical system.

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   AFib is often underdiagnosed in people with CKD because symptoms may be subtle.
• Stroke Irregular heart rhythms and calcium deposits in your arteries can raise your stroke risk.

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Many strategies that slow kidney disease progression also protect your heart. Controlling shared major risk factors such as blood pressure, diabetes, and cholesterol is key, Mehdi says.

Medications That Offer Dual Protection

Several medications now target kidney and cardiovascular risk, Mehdi says:

• SGLT2 Inhibitors Originally developed to treat type 2 diabetes, these medications help the kidneys remove excess glucose and sodium through the urine. Examples include empagliflozin (Jardiance), dapagliflozin (Farxiga), and canagliflozin (Invokana).

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• GLP-1 Receptor Agonists (GLP-1s) These medications reduce appetite, promote weight loss, and can improve blood sugar levels. GLP-1s are also shown to lower the risk of major cardiovascular events, including heart attack and stroke, particularly in people with diabetes or high cardiovascular risk.

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   Examples include semaglutide (Ozempic, Wegovy), tirzepatide (Zepbound), and dulaglutide (Trulicity).
• PCSK9 Inhibitors These injectable medications dramatically lower LDL (“bad”) cholesterol levels in people whose cholesterol remains high despite using statins and making lifestyle changes. Examples include evolocumab (Repatha), alirocumab (Praluent), and inclisiran (Leqvio).

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• Renin-Angiotensin-Aldosterone System Inhibitors These medications reduce activity in the hormone system that regulates blood pressure and fluid balance. This category includes angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ARBs). Examples include lisinopril (Prinivil, Zestril), losartan (Cozaar), and valsartan (Diovan).

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• Nonsteroidal Mineralocorticoid Receptor Antagonists These newer medications, including finerenone (Kerendia), block mineralocorticoid receptors involved in inflammation and scarring in the heart and kidneys.

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• Angiotensin Receptor-Neprilysin Inhibitor (ARNI) This medication combines an ARB with a neprilysin inhibitor to lower blood pressure and improve heart function. It is primarily used if you have heart failure and are not pumping out enough blood. Research shows that ARNIs may help kidney function in some people. One ARNI, sacubitril/valsartan (Entresto), is approved in the United States.

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Lifestyle Changes That Matter

Medication is only part of the equation. Mehdi recommends daily lifestyle choices that can help improve your kidney and heart health:

• Reduce sodium. Lowering salt intake helps control blood pressure and fluid retention.
• Limit processed foods. These often contain high sodium and phosphorus additives.
• Moderate how much protein you eat. Excess protein can increase kidney workload. Talk to your doctor or dietitian about what is right for you.
• Stay physically active. Regular movement improves blood pressure, blood sugar, and circulation.
• Maintain a healthy weight. Weight management reduces strain on both organs.
• Quit smoking. Smoking damages blood vessels and accelerates kidney disease and heart disease.

Finally, don’t overlook follow-up care.

“If you are a kidney patient, talk with your doctor about what you can do to protect your heart,” Bansal says. That may include tighter blood pressure control or evaluation if you develop symptoms such as shortness of breath, chest pain, or trouble walking.

Likewise, if you have heart disease, ask your doctor to check your kidney function.

“It is easy to overlook if you are not aware of the connection,” Bansal says.

• Chronic kidney disease and heart disease are closely linked because the kidneys help regulate blood pressure, fluid levels, and important minerals that affect the heart.
• When your kidneys don’t work properly, fluid buildup, high blood pressure, and mineral imbalances can strain your heart and increase your risk of heart failure and irregular heart rhythms.
• People with CKD are more likely to develop heart conditions such as left ventricular hypertrophy and coronary artery disease.
• Medications that protect the heart and kidneys, as well as lifestyle changes such as adjusting your diet and exercising, can help reduce your risks and improve your overall health.