Effects of a Supervised Training Program on Functional Capacity in Patients With HF and Cardiorenal Syndrome

Inclusion Criteria: * Patients diagnosed with heart failure according to 2021 ESC guidelines for Heart Failure. * Evidence of cardiorenal syndrome, defined as coexistent very high risk chronic kidney disease (CKD) (estimated glomerular filtration rate \[eGFR\] \<30 ml/min/1.73m2 or eGFR 30 to 44 ml/min/1.73m2 and Urine Albumin-Creatinine Ratio \[uACR\] \>30 mg/g) or rapidly progressive CKD (loss of \>5 ml/min/1.73m2 in one year). * Stable symptomatic heart failure patients (New York Heart Association functional class II-III/IV) during the last month. * Age ≥ 18 years old. * Willing to provide written informed consent. Exclusion Criteria: * Inability to perform a valid baseline cardiopulmonary exercise test. * Significant primary severe valve disease that is considered the main symptom driver. * Effort angina or signs of ischemia during CPET. * Primary cardiomyopathies. * Cardiac transplantation. * Any other comorbidity with a life expectancy of less than one year.