In this episode, Dr. Rangaswami discusses "renalism" - the systematic exclusion of patients with advanced chronic kidney disease (CKD) from heart failure trials and treatments. She explains the historical reasons behind this exclusion, recent positive trends in including more CKD patients in trials, and the challenges in enrolling these patients. Dr. Rangaswami highlights the importance of representing CKD patients in research and clinical practice, noting recent developments like new risk calculators that incorporate kidney function. She also provides practical insights on using guideline-directed medical therapies in patients with advanced CKD and heart failure, including the use of newer medications and potassium binders.