Acute declines in estimated glomerular filtration rate on enalapril and mortality and cardiovascular outcomes in patients with heart failure with reduced ejection fraction

Renin-angiotensin aldosterone inhibitor use at hospital discharge among patients with moderate to severe acute kidney injury and its association with recurrent acute kidney injury and mortality

“…Individualized decision-making based on these factors, accounting for each patient's risk for rehospitalization or recurrent AKI and arranging adequate follow-up for patients should continue to be prioritized. For example, recent studies have suggested that in certain populations, such as heart failure, 19,20 some decline in eGFR associated with RAASi still provides cardiovascular benefit without increasing mortality. These results suggest that providers should not be generally dissuaded from careful continuation or initiation of RAASi among those with strong indications who have previously experienced AKI.…”

“…Following weighting, the 4 groups were well-balanced across demographics, comorbidities, inpatient characteristics, AKI severity, discharge potassium, creatinine, length of stay, and number of subsequent rehospitalizations (Table 1b). The weighted rates of recurrent AKI per 100 person-years were 21.13 (95% CI, 19.57 -22.78) and 20.78 (19.20 -22.47) for prevalent RAASi users who continued and discontinued RAASi use respectively ( Table 2a). The weighted rates per 100 person-years among nonusers who were started on RAASi and not started on RAASi were 22.96 (21.33 -24.67) and 21.07 (19.51 -22.72), respectively.…”

“…34 The Cox proportional hazards models on recurrent AKI and on death estimated potentially causal associations with post-discharge RAASi use with each of those two outcomes. (19) 567 (18) 575 (19) 569 (18) 618 (19) Heart Failure*, n (%) 3176 (25) 764 (24) 801 (26) 777 (25) 835 (26) Advanced Liver Disease*, n (%) 798 (6) 207 7215 7194 (6) 182 (6) Chronic Obstructive Pulmonary Disease*, n (%) 3773 (30) 933 (30) 930 (30) 934 (30) 976 (30) Cancer (ICD-9)*, n (%) 2320 (19) 570 (18) 596 (19) 569 (18) 585 (18) Cerebrovascular Accident*, n (%)…”

Symptomkontrolle bei Herzinsuffizienzpatienten – was tun bei abfallender GFR und bei Hyperkaliämie?

“…Eine Nachanalyse der SOLVD-Studie fand, dass nach Initiation von Enalapril bei Patientinnen und Patienten mit HFrEF ein Abfall der eGFR um bis zu 10 % sogar mit einer signifikanten Senkung der Mortalität assoziiert war und ein Abfall um bis zu 35 % mit einer signifikanten Senkung der Hospitalisierungsrate. Ein Abfall der eGFR von bis zu 40 % war nicht mit einer erhöhten Mortalität verbunden [8]. Sofern die Nierenfunktion eines HI-Patienten nicht bereits erheblich eingeschränkt ist (CKD-Stadium G4, d. h. eGFR < 30 ml/min/1,73 m 2 ), ist daher ein Abfall der eGFR um bis zu 30 % kein Grund, die Therapie mit RAAS-Blockern kurzfristig zu verändern [5].…”

Continuation of renin-angiotensin-aldosterone system blockade therapy in acute decompensated heart failure

“…However, there is limited data on continuation of RAAS blockade therapy during hospitalization for ADHF and cardiorenal syndrome, with acute kidney injury (AKI) being the major reason for discontinuation of therapy, generally secondary to prerenal state from hypoperfusion. Several studies showed mortality benefit associated with continuation of RAAS blockade therapy during decompensated heart failure hospitalization, even after adjustment for severity of illness (Gilstrap et al, 2017) and in patients who developed moderate decline in eGFR (McCallum et al, 2019).…”