Cardiovascular Pharmacotherapy and Kidney Disease: Controversies and Practical Challenges

Cardiovascular disease and chronic kidney disease frequently coexist and amplify one another through shared risk factors, neurohormonal activation, inflammation, and complex hemodynamic interactions. As kidney function declines, cardiovascular risk rises sharply, yet the evidence base guiding pharmacotherapy becomes less direct. Many pivotal cardiovascular trials have excluded advanced kidney disease, while kidney focused studies may not fully capture cardiovascular endpoints, leaving clinicians to extrapolate across populations with different baseline risks, competing hazards, and drug handling.This Research Topic addresses the practical and sometimes contentious decisions that arise when applying cardiovascular pharmacotherapy in patients with impaired kidney function, including acute kidney injury risk, hyperkalemia, blood pressure instability, and challenges in interpreting changes in creatinine and albuminuria. It aims to clarify what should be continued, started, paused, or deprescribed across stages of chronic kidney disease, during intercurrent illness, and around procedures. By bringing together mechanistic insights, trial evidence, and real world implementation experience, the collection will propose pragmatic approaches to balancing short term safety with long term cardio renal protection.We welcome contributions spanning adult and older populations, diabetes and non diabetes kidney disease, dialysis and transplant settings, and heart failure, ischemic heart disease, hypertension, and arrhythmias. Submissions may include Original Research, Systematic Reviews, Meta analyses, Methods, Brief Research Reports, Clinical Trial protocols, and Perspectives or Clinical Practice pieces focused on implementation.• Initiation and titration strategies for RAAS inhibition, ARNI, beta blockers, MRAs, and SGLT2 inhibitors across CKD stages;• Hyperkalemia mitigation, diuretic optimization, and monitoring pathways that enable guideline directed therapy;• Interpreting kidney function changes: expected eGFR dips, AKI definitions, and when to hold or resume therapy;• Antithrombotic and antiarrhythmic management in CKD, including dosing, bleeding risk, and drug interactions;• Special scenarios: dialysis, transplant recipients, frailty, polypharmacy, perioperative care, and sick day rules. Topic editors: Marcin Welnicki, Beata Naumnik Source: https://www.frontiersin.org/research-topics/81358/cardiovascular-pharmacotherapy-and-kidney-disease-controversies-and-practical-challenges