Most patients hospitalized with heart failure and kidney disease say they want comfort-focused care, yet fewer than 40% have completed advance care planning documents, and many drastically underestimate their mortality risk. A new four-year study presented at the National Kidney Foundation's 2026 Spring Clinical Meetings reveals a critical communication breakdown between patients and their medical teams that could leave vulnerable people without the care they truly want when they need it most .

What's the Real Problem When Heart Failure Meets Kidney Disease?

Researchers surveyed 400 hospitalized patients with acute decompensated heart failure between 2020 and 2024, examining what they wanted from their care, what they expected to happen, and whether they had made advance plans. The findings were sobering. Among the study participants, 40% had chronic kidney disease (CKD), a condition affecting kidney function, and 16.5% experienced acute kidney injury, a sudden loss of kidney function . These overlapping conditions create what researchers call cardiovascular kidney metabolic syndrome, a dangerous interaction where heart and kidney problems compound each other.

The study uncovered a striking disconnect between patient preferences and their actual preparation for end-of-life care. While 60.6% of patients reported prioritizing comfort-focused care, fewer than 40% had completed key advance care planning documents such as living wills or healthcare power of attorney forms . Even more troubling, patients' expectations about their survival were often far too optimistic. Although 27% of patients died within one year of hospital discharge, only 5% believed they had a life expectancy of one year or less .

Why Are Patients Making Decisions Without Full Information?

The research revealed another critical gap: many patients expressed interest in intensive treatments, including dialysis and implanted heart pumps, often without having prior discussions with their care teams to inform their decision-making . This suggests that patients may be choosing aggressive interventions not because they truly want them, but because they haven't had honest conversations about what those treatments involve or what their realistic outcomes might be.

"We found that many patients value comfort-focused care, but these preferences are not always supported by clear conversations or advance care planning," stated Sydney Wong, presenter of the study. "Hospitalization is a critical moment to better align with what matters most to patients."

Sydney Wong, Study Presenter, National Kidney Foundation

The study also found that kidney disease status did not influence survey findings, meaning that patients with CKD or acute kidney injury had the same communication gaps as those without kidney complications . Preferences and expectations remained largely unchanged after discharge, highlighting missed opportunities for communication during hospitalization and in outpatient follow-up .

Steps to Improve Advance Care Planning Conversations

• Schedule dedicated conversations early: Don't wait for a crisis. When patients are first diagnosed with heart failure or kidney disease, healthcare providers should initiate conversations about what matters most to them, their values, and their preferences for future care.
• Use plain language about treatment options: Explain what dialysis actually involves, what an implanted heart pump means for daily life, and what comfort-focused care looks like in practical terms, not medical jargon.
• Complete advance care planning documents: Work with patients to fill out living wills, healthcare power of attorney forms, and POLST (Physician Orders for Life-Sustaining Treatment) forms while they are stable and able to think clearly about their wishes.
• Revisit preferences after hospitalization: A hospital stay is a wake-up call. Follow-up appointments should include conversations about whether the patient's preferences have changed based on their experience.
• Involve the entire care team: Nurses, social workers, palliative care specialists, and nephrologists should all reinforce consistent messages about patient goals and realistic outcomes.

The findings underscore a broader challenge in kidney and heart disease care. Chronic kidney disease affects 1 in 7 adults in the United States, yet 90% of those affected are unaware they have the condition . When patients do learn they have kidney disease, many don't fully understand what it means for their future or what their treatment options really entail.

The research will be presented in a late-breaking oral session at the National Kidney Foundation's 2026 Spring Clinical Meetings on Thursday, May 7, from 2:00 p.m. to 3:30 p.m., in New Orleans . The findings highlight the need for better conversations, shared decision-making, and advance care planning for patients with heart failure and kidney disease. When patients and doctors align on what matters most, care becomes more meaningful and outcomes improve.