Chronic kidney disease (CKD) is independently linked to new-onset heart failure across all types, with the strongest connection found in heart failure with preserved ejection fraction (HFpEF), a condition that becomes more common with age. A large Swedish study of over 100,000 patients found that CKD was associated with 63% higher odds of developing heart failure overall, but the risk jumped to 146% higher for the HFpEF type specifically.

What Is the Connection Between Kidney Disease and Heart Failure?

Your kidneys and heart are deeply interconnected. The heart pumps 24% of its blood output to the kidneys at rest, making them vital organs for filtering waste and regulating blood pressure. When kidney function declines, this delicate balance breaks down. Researchers from Karolinska Institutet in Stockholm analyzed data from the Swedish Heart Failure Registry between 2005 and 2021, comparing nearly 52,000 patients with new-onset heart failure to a matched group of 52,000 people without heart failure.

The study classified heart failure into three types based on ejection fraction, which measures how well the heart pumps blood. The findings showed that CKD's impact varied significantly by type. HFpEF, where the heart's pumping strength is preserved but it struggles to relax and fill with blood, showed the strongest association with kidney disease. This matters because HFpEF is increasingly common in older adults and has fewer treatment options than other heart failure types.

How Does Kidney Disease Severity Affect Heart Failure Risk?

The research revealed that as kidney disease worsens, the risk of developing HFpEF climbs sharply. Researchers grouped patients into five kidney disease stages based on estimated glomerular filtration rate (eGFR), a measure of how well kidneys filter waste. The stages range from G2 (mild decline, eGFR 60-89) through G5 (kidney failure, eGFR below 15).

The association between CKD and HFpEF strengthened considerably as kidney disease advanced from mild to moderate and severe stages. This pattern suggests that preventing kidney disease progression could be crucial for reducing heart failure risk in vulnerable populations.

Why Is Chronic Kidney Disease Often Missed?

One of the most troubling aspects of CKD is its silent nature. Approximately 9 in 10 people with early-stage chronic kidney disease have no symptoms and remain unaware of their condition. This means millions of Americans are at risk for both kidney failure and heart complications without knowing it.

CKD affects more than 1 in 7 U.S. adults, an estimated 37 million Americans, and one-third of the U.S. population is at risk for developing it. The disease is the ninth leading cause of death in the United States and worldwide. Beyond heart failure, CKD increases the risk of all-cause mortality, cardiovascular disease, and progression to kidney failure, even when accounting for other risk factors like high blood pressure and diabetes.

Who Is Most at Risk for Chronic Kidney Disease?

Several conditions and lifestyle factors significantly increase CKD risk. Diabetes and high blood pressure together account for two-thirds of all CKD cases. Here's what puts you at higher risk:

• Diabetes: An estimated 38% of people with diabetes will develop CKD, and nearly half of adults with type 1 diabetes have signs of kidney disease. High blood sugar damages the kidney's blood vessels and filtering units, promotes inflammation inside the kidneys, and reduces blood flow in tiny blood vessels.
• High Blood Pressure: Hypertension can constrict and narrow blood vessels supplying the kidneys, eventually damaging them and reducing blood flow. High blood pressure can also scar the kidneys and damage their filtering mechanisms.
• Obesity: Obesity increases the lifetime risk of CKD by 25% compared with people of normal weight.
• Age and Mental Health: Older adults aged 60 and above with Alzheimer's dementia or depression have a 67% and 44% increased risk of end-stage kidney disease, respectively.
• Medication Use: Frequent and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) can cause permanent kidney damage.

How to Protect Your Kidney and Heart Health

The good news is that lifestyle changes can significantly reduce your risk for both CKD and heart failure. Here are evidence-based strategies to protect your kidneys:

• Monitor Your Blood Pressure: Keep your blood pressure consistently below 120/80 mmHg. Adopting a largely plant-based diet of unrefined foods and engaging in daily moderate exercise can substantially decrease your risk for type 2 diabetes and hypertension.
• Manage Protein Intake: Eat adequate but not excessive amounts of protein, especially if you're over 65 or have other CKD risk factors. Excess protein, particularly animal protein, can damage the kidney's filtering units. Consider substituting soy protein for animal protein, as soy milk consumption is associated with better blood pressure control among diabetic patients with kidney disease.
• Reduce Sodium Intake: Limit salt to about one teaspoon per day for healthy adults. A high sodium diet accelerates kidney function decline and increases the stiffness of arteries, raising blood pressure risk. Avoid aged cheese, processed foods, and pickles, which are typically high in sodium.
• Avoid Artificial Sweeteners and Diet Sodas: People who drink two or more diet sodas daily have double the risk of faster kidney function decline, even after accounting for age, obesity, high blood pressure, diabetes, and other factors. Regular sodas with high fructose corn syrup and artificially sweetened beverages also damage the kidneys.
• Eat Whole Fruits and Vegetables: Whole fruits and vegetables are rich in potassium, and higher levels of urinary potassium excretion are linked with slower kidney function decline.

What Tests Can Detect Kidney Disease Early?

The National Kidney Foundation recommends two simple tests to check for CKD. Both are needed to get a clear picture of your kidney health:

• Blood Test (eGFR): The estimated glomerular filtration rate measures how well your kidneys filter waste. An eGFR under 60 mL/min/1.73 m² may indicate kidney disease.
• Urine Test (uACR): The urine albumin-creatinine ratio detects protein in your urine, a sign of kidney damage. A uACR over 30 may indicate kidney disease.

Having an eGFR under 60 and/or a uACR over 30 for three months or more is a sign you may have kidney disease. If you have risk factors like diabetes, high blood pressure, obesity, or prediabetes, talk to your healthcare provider about getting tested.

What Are the Broader Health Impacts of Untreated Kidney Disease?

When kidney function declines, the effects ripple throughout your body. Damaged kidneys can no longer regulate red blood cell production, leading to anemia, which causes fatigue and weakness. They also lose the ability to balance electrolytes like potassium, which can trigger irregular heartbeats and even death if levels become too high.

Other complications include extra fluid buildup and swelling in the legs, a weakened immune system, loss of appetite or nausea, confusion and brain fog, depression, low calcium levels, elevated phosphorus, and osteoporosis. These cascading effects underscore why early detection and prevention are so critical.

"Our findings have important implications for the management of patients with CKD. The prevention of HF in this high-risk population should be considered a public health priority," the researchers of the study wrote.

Study researchers, Karolinska Institutet, Stockholm, Sweden

The Swedish study was published online on July 19, 2026, in ESC Heart Failure and included researchers from Karolinska Institutet led by Valeria Valente. While the research was conducted in Sweden, the findings have global relevance, as CKD affects 10-16% of the adult population in Asia, Australia, Europe, and the United States.