Ivabradine, Heart Failure and Chronic Kidney Disease

Abstract

The incidence and prevalence of congestive heart failure are actually increasing worldwide, especially in Western countries. In Europe and the United States, congestive heart failure represents a disabling clinical disease, accountable for increased hospitalization and health care costs. European guidelines have underlined the importance of pharmacological treatment to improve both patients' outcomes and quality of life. The latest clinical trials to evaluate ivabradine's efficacy have underlined its usefulness as a stand-alone medication and in combination with conventional congestive heart failure therapy, including in chronic kidney disease patients.

Effects of ivabradine on the prevention of intradialytic hypotension in a dialytic patient with heart failure with reduced ejection fraction

“…The following issues are not yet understood: (1) whether the preventive effect of ivabradine on IDH is identified in patients with preserved ejection fraction; (2) whether ivabradine increases the stroke volume in HD patients with left ventricular hypertrophy, such as HD-related amyloidosis, which cannot lead to a sufficient increase in the left ventricular filling volume; (3) whether the prevention of IDH by ivabradine contributes to improvement in long-term prognosis in HD patients; and (4) whether ivabradine use in HD patient is safe. The efficacy and the safety of ivabradine for patients with renal dysfunction, including those on HD, were previously reviewed 14. However, the use of ivabradine for the treatment of heart failure in HD patients should be carefully considered until sound evidence is available.…”

Advancing heart failure management: A comparative analysis of Ivabradine and Sacubitril / valsartan

“…Based on inherited genetic variations in either CYP3A4 or HCN4, certain patient groups may respond well to treatment while others may not; however, conclusive evidence is still missing [22] . For patients with GFR greater than 15 mL/min and chronic renal disease, no dose change is necessary; however, little information is available for those with GFR less than 15 mL/min [23] .…”

“…Heart rate is governed by a multitude of intricate processes, all of which are mediated by the autonomic nervous system. These mechanisms include baroreceptors found in the atria and ventricles, reflexes mediated via the carotid and aortic sinuses, and neurohormonal and metabolic regulation [25] . Ivabradine does not impact the level of other elements that can influence heart rate availability of open channels, but it does affect the myocardium's ability to generate an electrical impulse.…”

Coronary artery disease (CAD) in chronic kidney disease patients

“…L'ivabradina è un farmaco di relativa nuova immissione sul mercato ed è in grado di inibire le correnti If presenti a livello del nodo seno-atriale, determinando una riduzione della frequenza cardiaca e un miglioramento della sintomatologia anginosa. Può essere impiegata in luogo oppure in associazione con i β-bloccanti, ma il suo utilizzo dovrebbe essere evitato nei pazienti in terapia con verapamil e/o diltiazem (42). Allo stato attuale sono a disposizione pochi dati clinici relativi all'efficacia e alla sicurezza d'impiego nei pazienti affetti da CKD; per tale motivo, la prescrizione di ivabradina va effettuata con cautela in questa popolazione di pazienti (42).…”