Long-term changes of renal function in relation to ace inhibitor/angiotensin receptor blocker dosing in patients with heart failure and chronic kidney disease

Fröhlich, Hanna; Nelges, Christoph; Täger, Tobias; Schwenger, Vedat; Cebola, Rita; Schnorbach, Johannes; Goode, Kevin; Kazmi, Syed; Katus, Hugo A.; Cleland, John G.F.; Clark, Andrew L.; Frankenstein, Lutz

doi:10.1016/j.ahj.2016.03.024

Cited by 21 publications

(18 citation statements)

References 30 publications

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“…ACE and ACE2 play different roles in RAS; ACE generates Angiotensin II, whereas ACE2 is a negative regulator of the system, decreasing Angiotensin II (Crackower et al 2002). The abnormal increase of Angiotensin II was reported mostly associated with hypertension and heart failures (Packer and McMurray, 2017), and sometimes also lung and renal dysfunctions (Fröhlich et al, 2016;Kuba et al, 2005; 2017; Torres et al, 2014). We measured the plasma level of Angiotensin II from 2019-nCoV infected patients and healthy individuals, the plasma levels of Angiotensin II from 2019-nCoV infected patients were significantly higher than that of healthy individuals ( Figure 6A).…”

Section: Resultsmentioning

confidence: 99%

Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury

Liu¹,

Yang²,

Zhang³

et al. 2020

Sci. Sin.-Vitae

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The outbreak of the 2019-nCoV infection began in December 2019 in Wuhan, Hubei province, and rapidly spread to many provinces in China as well as other countries. Here we report the epidemiological, clinical, laboratory, and radiological characteristics, as well as potential biomarkers for predicting disease severity in 2019-nCoV-infected patients in Shenzhen, China. All 12 cases of the 2019-nCoV-infected patients developed pneumonia and half of them developed acute respiratory distress syndrome (ARDS). The most common laboratory abnormalities were hypoalbuminemia, lymphopenia, decreased percentage of lymphocytes (LYM) and neutrophils (NEU), elevated C-reactive protein (CRP) and lactate dehydrogenase (LDH), and decreased CD8 count. The viral load of 2019-nCoV detected from patient respiratory tracts was positively linked to lung disease severity. ALB, LYM, LYM (%), LDH, NEU (%), and CRP were highly correlated to the acute lung injury. Age, viral load, lung injury score, and blood biochemistry indexes, albumin (ALB), CRP, LDH, LYM (%), LYM, and NEU (%), may be predictors of disease severity. Moreover, the Angiotensin II level in the plasma sample from 2019-nCoV infected patients was markedly elevated and linearly associated to viral load and lung injury. Our results suggest a number of potential diagnosis biomarkers and angiotensin receptor blocker (ARB) drugs for potential repurposing treatment of 2019-nCoV infection.

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Section: Resultsmentioning

confidence: 99%

Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury

Liu¹,

Yang²,

Zhang³

et al. 2020

Sci. Sin.-Vitae

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“…The present study showed insignificant difference between patients with and those without CKD based on the administration of NSAID or/and ACEI/ARBs. Still, ACEI/ARBs were classified as renoprotective based on criteria that depend on the degree of renal dysfunction, renal function response and presence of comorbidities (Frohlich et al 2016). ACE inhibitors have showed the ability to reduce progression of ESKD compared with a placebo group, but no statistical significant was found between ACE inhibitors and other antihypertensive monotherapies such as ARBs, B blockers or calcium channel blockers regarding developing risk for ESKD, mortality and clinical vascular and renal outcomes (Steventon et al 2014).…”

Section: Discussionmentioning

confidence: 99%

Under‐diagnosed chronic kidney disease in Jordanian adults: prevalence and correlates

Khalil

Abed

Ahmad

et al. 2017

Journal of Renal Care

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“…This difference could be explained by their exclusion of CKD stage 5 and dialysis patients and the fact that their follow-up period was fixed at 12 months. 7 The varying follow-up period in our study meant that a proportion of patients was at early stages of medication optimization. With regard to other possible factors affecting medication optimization, our study showed that severity of CKD and nature of HF did not have an influence on the likelihood of successful initiation or dose up-titration similar to a study by Heywood et al 2 Risk of hyperkalaemia in patients with successful RAASi dose up-titration in our study was comparable to that reported in clinical trials.…”

Section: Figurementioning

confidence: 96%

Management and outcomes of heart failure patients with CKD: experience from an inter‐disciplinary clinic

et al. 2020

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Aims CKD-HF patients suffer excess hospitalization and mortality, often under-treated with life-prolonging medications due to fear of worsening renal function and hyperkalaemia. Yet, role of inter-disciplinary working in improving therapy is unknown, which this study aims to investigate. Methods and results Clinical, biochemical data, and medications at first and last clinic visit were obtained from patient records for 124 patients seen in kidney failure-heart failure clinic (23 March 2017 to 11 April 2019). Medication dose groups (none, low, and high dose), number of RAASi agents, and blood test results were compared between first and last visit in patients with at least two clinic visits (n = 97). Patient characteristics were age 78.5 years (IQR 68.1-84.4 years), male 67.7%, diabetes 51.6%, moderate (45.2%) vs. severe (39.5%) CKD, HF with reduced ejection fraction (HFrEF) (49.2%), follow-up 234 days (IQR 121-441 days). HFrEF was associated with increased risk of death (adjusted OR 4.49, 95% CI 1.43-14.05; P = 0.01). Distributions of patients according to number of RAASi agents they were on differed between first and last visit (P = 0.03). Dosage was increased in 25.9% for beta-blockers, 33.0% for ACEi/ARBs, and 17.5% for MRAs. Distributions of patients across MRA dosage groups was different (P = 0.03), with higher proportions on higher dosages at last visit, without significant changes in serum potassium or creatinine. Serum ferritin improved (131.0 vs. 267.5 μg/L; P < 0.001), and fewer patients had iron deficiency (56.7% vs. 26.8%; P = 0.002) at last visit compared to the first. Conclusions This inter-disciplinary clinic improved guideline-recommended medication prescription, MRA dosages in CKD-HF patients without significant biochemical abnormality, and iron status. A prospectively designed study with medication titration protocol and defined patient-centred outcomes is needed to further assess effectiveness of such clinic.

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Long-term changes of renal function in relation to ace inhibitor/angiotensin receptor blocker dosing in patients with heart failure and chronic kidney disease

Abstract: Fröhlich, H. et al. (2016) Long-term changes of renal function in relation to ace inhibitor/angiotensin receptor blocker dosing in patients with heart failure and chronic kidney disease.

Cited by 21 publications

References 30 publications

Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury

Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury

Under‐diagnosed chronic kidney disease in Jordanian adults: prevalence and correlates

Management and outcomes of heart failure patients with CKD: experience from an inter‐disciplinary clinic

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