Medical Management of Heart Failure With Reduced Ejection Fraction in Patients With Advanced Renal Disease

Hein, Aaron; Scialla, Julia J.; Edmonston, Daniel L.; Cooper, Lauren B.; DeVore, Adam D.; Mentz, Robert J.

doi:10.1016/j.jchf.2019.02.009

Cited by 44 publications

(28 citation statements)

References 61 publications

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“…Cumulative studies have shown a bi‐directional relationship between CKD and CVD, and the development of either disease may accelerate the progression of the other. Approximately 10% of patients with heart failure (HF) have a severe reduction of estimated glomerular filtration rate (eGFR), and patients with CKD are prone to develop CVD 3 . Mechanisms, including hypervolemia, inflammation and endothelial dysfunction, worsen the course of both CKD and HF 4 .…”

Section: What Is Known and Objectivementioning

confidence: 99%

“…Several randomized controlled trials (RCTs) have revealed that renin‐angiotensin‐aldosterone system inhibition (RASi) can decrease the risk of cardiovascular events, HF hospitalizations and mortality 3 . Nevertheless, renal adverse events are observed frequently during clinical practice, when treating patients with angiotensin‐converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) 5 .…”

Section: What Is Known and Objectivementioning

confidence: 99%

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Renal safety and efficacy of angiotensin receptor‐neprilysin inhibitor: A meta‐analysis of randomized controlled trials

et al. 2020

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What is known and objective Angiotensin receptor‐neprilysin inhibitor (ARNi) therapy has been shown to improve cardiovascular outcomes in the Prospective Comparison of ARNi with angiotensin‐converting enzyme inhibitor to Determine the Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM‐HF) study. However, the renal safety and efficacy of ARNi remains controversial. This meta‐analysis aimed to assess the renal safety and efficacy of angiotensin receptor‐neprilysin inhibitor (ARNi). Methods and Results PubMed, EMBASE, the Cochrane Library, Web of Science and Clinicaltrials.gov were searched for randomized controlled trials. Eleven studies that covered 21,716 patients were included. ARNi was superior to angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers, in terms of risk of renal dysfunction, estimated glomerular filtration rate (eGFR) decline and elevated serum potassium levels, and higher risk of increase in urine albumin‐to‐creatinine ratio. However, there was no difference in the probability of hyperkalemia and elevated serum creatinine levels. The incidence of eGFR decrease in patients with chronic kidney disease (CKD) was lower in patients who received ARNi, although ARNi use was not associated with higher risk of renal dysfunction in patients with CKD. What is new and conclusion. Available evidence supports the effectiveness of ARNi on improving renal outcome. Compared with renin‐angiotensin‐aldosterone system inhibition, ARNi protects against renal impairment, since ARNi users have a lower risk of renal dysfunction and a higher eGFR, without an increased risk of hyperkalemia. However, its benefit for CKD patients still warrants further investigation.

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Section: What Is Known and Objectivementioning

confidence: 99%

Section: What Is Known and Objectivementioning

confidence: 99%

Renal safety and efficacy of angiotensin receptor‐neprilysin inhibitor: A meta‐analysis of randomized controlled trials

et al. 2020

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“…Despite the well-established benefits of MRAs in HFrEF, just as with RAS inhibitors and ARNIs, there is concern for hyperkalemia in patients with advanced CKD (Hein et al, 2019). The SPin-D trial randomized 129 patients on maintenance HD to placebo or spironolactone 12.5 mg, 25 mg, or 50 mg daily.…”

Section: Mineralocorticoid Receptor Antagonists (Mras)mentioning

confidence: 99%

Management of heart failure in patients with end-stage kidney disease on maintenance dialysis: a practical guide

Joseph

Palardy

Bhave

2020

Reviews in Cardiovascular Medicine

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End-stage kidney disease (ESKD) and heart failure (HF) often coexist and must be managed simultaneously. Multidisciplinary collaboration between nephrology and cardiology is critical when treating patients with such complicated physiology. There is no "one-size-fits-all" approach to the evaluation of patients with new left ventricular systolic dysfunction, and diagnostic testing should be adapted to an individual's risk factors. Guideline-directed medical therapy (GDMT) for systolic heart failure should be employed in these patients. While limited randomized data exist, observational data and post hoc analyses suggest that GDMT, including renin angiotensin aldosterone system inhibitors, is associated with improved cardiovascular outcomes and can be safely initiated at low doses with close monitoring of kidney function in this population. Volume status is typically managed through ultrafiltration, so close communication between cardiology and nephrology is necessary to achieve a patient's optimal dry weight and mitigate intradialytic hypotension.Patient education and engagement regarding sodium and fluid restriction is crucial, and symptom burden should be reassessed following changes to the dialysis regimen.

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“…To identify critical practical barriers and gaps in care and knowledge, several scientific statements have been developed to summarize the current findings in areas with incomplete evidence. 5,6 Unfortunately, these efforts have demonstrated that a lack of evidence in this field is pervasive, with inconclusive evidence regarding important outcomes, such as the quality of life, physical function, and maintenance of independence, in patients with advanced age and concomitant disease, making it difficult to identify appropriate interventions. Accordingly, there is a critical need for more practical guidance in areas with incomplete evidence to transform clinical guideline recommendations into clinically actionable information.…”

Section: Introductionmentioning

confidence: 99%

Appropriateness rating for the application of optimal medical therapy and multidisciplinary care among heart failure patients

et al. 2020

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Aims Clinical guidelines for improving the patients' quality of care vary in clinical practice, particularly in super‐aging societies, like in Japan. We aimed to develop a set of appropriate‐use criteria (AUC) for contemporary heart failure (HF) management to assist physicians in decision making. Methods and results With the use of the RAND methodology, a multidisciplinary writing group developed patient‐based clinical scenarios in 10 selected key topics, stratified mainly by HF stage, age, and renal function. Nine nationally recognized expert panellists independently rated the clinical scenario appropriateness twice on a scale of 1–9, as ‘appropriate’ (7–9), ‘may be appropriate’ (4–6), or ‘rarely appropriate’ (1–3). Decisions were based on clinical evidence and professional opinions in the context of available resource use and costs. An interactive round‐table discussion was held between the first and second ratings; the median score of the nine experts was then assigned to an appropriate‐use category. Most clinical scenarios without strong evidence were evaluated as ‘may be appropriate’. Frailty assessments in elderly patients (age ≥ 75 years), regardless of the HF stage, and advanced care planning in patients with stage C/D HF, regardless of age, were considered ‘appropriate’. For HF with reduced ejection fraction, beta‐blocker administration in elderly patients (age ≥ 75 years) with heart rate < 50 b.p.m. and mineral corticosteroid receptor antagonist use in elderly patients (age ≥ 75 years) with an estimated glomerular filtration rate < 30 mL/min/1.73 m2 were considered ‘rarely appropriate’. Conclusions The HF management AUC provide a practical guide for physicians regarding scenarios commonly encountered in daily practice.

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Medical Management of Heart Failure With Reduced Ejection Fraction in Patients With Advanced Renal Disease

Cited by 44 publications

References 61 publications

Renal safety and efficacy of angiotensin receptor‐neprilysin inhibitor: A meta‐analysis of randomized controlled trials

Renal safety and efficacy of angiotensin receptor‐neprilysin inhibitor: A meta‐analysis of randomized controlled trials

Management of heart failure in patients with end-stage kidney disease on maintenance dialysis: a practical guide

Appropriateness rating for the application of optimal medical therapy and multidisciplinary care among heart failure patients

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