The Link Between Heart and Kidney Disease 

The kidneys and the heart usually work together in lockstep as the heart pumps blood to the kidneys, which removes toxins from the body. But when one becomes dysfunctional, the other organ suffers, too.

American Heart Month presents an opportunity to examine the close and common link between kidney disease and cardiovascular disease. And considering this connection amplifies the importance of value-based care approaches to treat people holistically.

The kidney-heart connection

Ample research informs us that kidney disease can trigger or worsen heart disease, while poor heart function can have a negative impact on kidney function. High blood pressure and diabetes are major risk factors for kidney and heart disease, another indication of the relationship between the two organs. Changes in blood pressure caused by chronic kidney disease (CKD) can lead directly to heart disease, and high blood sugar levels have been proven to damage kidneys and their functioning.

As kidney disease progresses, the kidneys are increasingly unable to remove toxins and fluid from the body. This can lead to an imbalance in electrolytes. The end result can be worsening congestive heart failure or serious arrythmias.

Many patients with CKD will die of heart-related conditions and events before they even reach end-stage kidney disease (ESKD) and need dialysis. According to public research, more than half of deaths in patients with ESKD are attributable to underlying cardiovascular disease.

This is why screening, early intervention, and monitoring are so critical to improving outcomes for patients with either or both diseases.

In the kidney care payer programs in which we take risk, we see many patients with advanced kidney disease also coming in with advanced cardiovascular disease. These patients have had prior heart attacks, have stents, have heart failure, or any number of cardiovascular conditions that exacerbate their kidney disease, decrease quality of life, and can lead to significantly increased chances of early death.

Moving care upstream

So, there is a real opportunity to look further upstream in the process to identify people at risk of kidney disease, cardiovascular disease, or both. This early warning would allow us to intervene sooner, giving providers time to make a positive difference through lifestyle changes and medication. Smoking cessation, controlling obesity, and stabilizing blood sugar are all ways that kidney disease and heart disease can be managed, stopping or slowing them considerably.

In addition to earlier detection, there are very clear benefits to coordinating care between nephrologists, cardiologists, and primary care providers (PCPs). For nephrologists, there is considerable overlap with their kidney disease patients and cardiovascular disease risk factors and progression. When providers work together to treat the whole patient, not just factors of a particular disease or condition, we can better manage the patient’s total health and wellness.

The value-based care approach

Prevention, early detection, proactive disease management, and care coordination are core components of Interwell Health’s value-based care approach. Aligning our practices around these principles has significant positive effects on patient outcomes, provider reimbursement, and reduction of overall healthcare spend.

As we move away from pay-for-service models to value-based care pay-for-performance, we must continue to facilitate communication between specialists, and between specialists and PCPs. This allows providers a much more complete, comprehensive understanding of each patient that amplifies the power of value-based care.

Value-based kidney care models align incentives to enable nephrologists to treat patients holistically rather than just for the symptoms that brought them to the office. Interwell supports practices in value-based arrangements with education, tools, social workers, nurses, dietitians, and pharmacists to enable clinical and financial success.

These resources give nephrologists the means to better manage and empower their patients with cardiovascular disease, keeping them healthier for longer. This has tremendous upside for patients and their families, physician practices, and the healthcare system, as a whole.

Value-based care models offer tremendous opportunities to lessen the human and financial costs of kidney and cardiovascular disease. Applying value-based principles such as early identification and close care coordination to patients with kidney disease will naturally address co-existing heart conditions, positively affecting the lives of millions of Americans every year.