Renal impairment an impediment to heart transplantation?

Chronic kidney disease and chronic heart failure are now recognized as closely intertwined entities. The noxious interactions between the heart and kidney systems as part of the so-called cardiorenal syndrome is a matter of great concern for heart transplant candidates. Not only is chronic kidney disease a commonly associated comorbidity, but its detrimental effect on the outcome of heart transplantation is now well established. In the more advanced stages of kidney disease, it may even deter physicians from carrying out heart transplantation in potential candidates. This review offers insights on epidemiological issues regarding chronic kidney disease among patients awaiting heart transplantation as well as its impact on the outcomes related with heart transplantations. Finally, emerging therapeutic opportunities which may benefit heart transplant candidates with the most severe renal impairment will be reviewed with a special emphasis on combined heart-kidney transplantation.