CKD and Heart failure has a bidirectional relationship. Excessive afterload due to long-standing hypertension and arterial stiffness, as well as excessive preload due to salt and water retention, are hemodynamic risk factors for chronic HF in patients with CKD. 
The median survival of dialysis patients with baseline HF is 36 months, compared to 62 months for those who do not have baseline HF. Several studies were conducted on patient outcomes of patients with HF undergoing kidney transplantation showing patients with reduced EF can be safely transplanted with no increased risk of intraoperative and postoperative cardiac events or graft loss at one year.  However  other studies show that HF at the time of transplantation is associated with a higher risk of mortality, cardiovascular events, and graft failure.
This study retrospectively studied 42 charts of patients with heart failure with reduced ejection fraction who have undergone kidney transplantation done between January 2016-June 2021.
Most patients are male with a mean age of 36.8. Majority of patients have hypertension and Diabetes mellitus. 2d echo results showed mean values of 31.82 with the lowest recorded EF of 17%. Majority utilized general endotracheal anesthesia. CVP monitoring was used in 42.9%. Mean duration of anesthesia was 4.26hours. Intraoperative blood loss was 307.86ml with the highest at 1300ml requiring transfusion of LDPRBC. PNNS was the fluid most utilized. Mean fluids infused was 1820.24ml. Graft function was immediate with mean onset of diuresis at 7.95min. Intraoperative hypotension was treated  mostly by Ephedrine followed by Dopamine. Mean 24hr urine output showed 12676.02 ml. Serial egfr on  1st, 2nd and 3rdday were 26.69, 70.19 and 83.43. Hypotension is the most common postoperative complication. Significant association between duration of anesthesia and blood loss on eGFR results on days 2 and 3 were noted.
Perioperative anesthetic management of patients with heart failure with reduced ejection fraction undergoing kidney transplant done at this institution produced similar results with the other studies. Although invasive procedures to monitor cardiac output were not done in our institution, the research yielded similar results such as immediate graft function, amount of fluids and complications such as incidence of congestion, pulmonary support and dialysis within 7 days. Lesser duration of anesthesia and blood loss yielded better post-operative eGFR.