Beyond the Dialysis Machine: Shaping the Future of Kidney and Cardiovascular Health

Christopher El Mouhayyar, MD: My interest started early—I have a family history of kidney disease, and my grandfather was on dialysis, so I saw firsthand how difficult that experience can be. In practice, it’s still a huge struggle for many patients. Dialysis is almost like a job—it takes over their lives, with hours in treatment and days spent recovering afterward. My goal is to keep patients out of the hospital and preserve their quality of life, while making sure we’re truly addressing what’s happening with them as a whole.

El Mouhayyar: There’s a lot of overlap between how the heart and kidneys function. The kidneys receive about 25% of the blood the heart pumps, so they’re a major component of the system. When the heart is damaged, it can affect the kidneys, and when the kidneys are not working properly, they can affect the heart in return. One key role of the kidneys is removing excess fluid from the body through urine production. If that fluid builds up, it can overwhelm the heart’s ability to pump. So it becomes a cycle—they function as two halves of a whole.

El Mouhayyar: One of the biggest gaps is that we do not have a clear definition of heart failure in people with end-stage kidney disease, which is the most advanced stage of kidney failure. At this stage, patients require dialysis, a process that artificially filters the blood when the kidneys can no longer do so on their own. When someone has symptoms like shortness of breath, it’s not always clear what’s driving it. Is it true heart failure, where the heart itself isn’t functioning properly? Or is it simply that we’re not removing enough fluid during dialysis? That distinction is critical, but the current scientific literature doesn’t give us a clear framework. That’s what makes this area both challenging and important to study.

El Mouhayyar: There are several barriers that need to be addressed. Access is a major one—many patients can’t get the medications they need because of lack of insurance or high cost. Clinicians also need to be proactive in adjusting care and monitoring patients closely. More broadly, dialysis has been a relatively static field for decades, with limited innovation despite the number of patients who depend on it. Meaningful progress will require more research, funding, and new approaches.