Chronic kidney disease and valvular heart disease: State of the art

Chronic kidney disease (CKD) and valvular heart disease (VHD) frequently coexist and are associated with a significant increase in morbidity and mortality. Their interplay is complex and multifactorial, involving shared pathophysiological mechanisms such as chronic inflammation, mineral and bone disorder, vascular and valvular calcification, and neurohormonal activation. These factors contribute to a bidirectional relationship in which each condition can exacerbate the progression and clinical consequences of the other. This review provides a comprehensive synthesis of the current evidence on the epidemiology, pathogenesis, and clinical impact of the CKD–VHD association. Special attention is given to the mechanisms underlying valvular calcification in the uremic milieu, the diagnostic challenges posed by overlapping symptoms, and the prognostic implications of valvular disease in patients with impaired renal function. Furthermore, this paper critically examines the available therapeutic options, including medical management, surgical and transcatheter interventions, and their outcomes in CKD patients. Given the limited evidence from randomized controlled trials in this population, our work also identifies key knowledge gaps and highlights future research directions, advocating for multidisciplinary approaches and tailored strategies. A better understanding of this cardio-renal interaction is crucial to optimize clinical decision-making and improve patient outcomes.