Representation of Chronic Kidney Disease in Randomized Controlled Trials Among Patients With Heart failure With Reduced Ejection Fraction: A Systematic Review

Lo, Kevin Bryan; Essa, Hani; Wattoo, Ammaar; Gulab, Asma; Akhtar, Hamza; Al-Sudani, Hussein; Angelim, Lucas; Helfman, Beth; Peterson, Eric; Brousas, Sophia; Whybrow-Huppatz, Isabel; Yazdanyar, Ali; Sankaranarayanan, Rajiv; Rangaswami, Janani

doi:10.1016/j.cpcardiol.2021.101047

Cited by 5 publications

(3 citation statements)

References 24 publications

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“…Specifically, we found untreated patients were significantly older than those with nephrologist consultation. Kidney failure in older people is usually associated with other comorbidities such as dementia, cognitive impairment [25,26], chronic heart failure, cardiovascular disease [27,28], diabetes, and hypertension [1,2,29], which dominate the clinical picture in ageing people. CKD is an indolent disease, which can limit patients' awareness [30][31][32] and, likely, general practitioners' diagnoses.…”

Section: Discussionmentioning

confidence: 99%

Stage 5 Chronic Kidney Disease: Epidemiological Analysis in a NorthEastern District of Italy Focusing on Access to Nephrological Care

Martino,

Fanton,

Zanetti

et al. 2024

JCM

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Background: We conducted a retrospective epidemiological study about the prevalence of stage 5 chronic kidney disease (CKD) in a high-income district, comparing some demographic characteristics and outcomes of those patients who had nephrological consultations and those who had not. Results: In a district of 400,000 adult subjects in 2020, 925 patients had an estimated glomerular filtration rate (eGFR) under 15 mL/min and CKD. In the same period, 747 (80.4%) patients were assessed by nephrologists, while 178 (19.6%) were not. Age (88 vs. 75, p < 0.0001), female gender (66.3% vs. 47%, p < 0.001), and eGFR (12 vs. 9 mL/min, p < 0.001) were significantly different in the patients assessed by a nephrologist as compared those who did not have nephrological care. Furthermore, unfollowed CKD patients had a significantly higher death rate, 83.1% versus 14.3% (p < 0.0001). Conclusions: About 20% of ESKD patients did not receive a nephrologist consultation. Older people and women were more likely not to be referred to nephrology clinics. Unfollowed patients with stage 5 CKD had a significantly higher death rate.

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Section: Discussionmentioning

confidence: 99%

Stage 5 Chronic Kidney Disease: Epidemiological Analysis in a NorthEastern District of Italy Focusing on Access to Nephrological Care

Martino,

Fanton,

Zanetti

et al. 2024

JCM

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“…Finally, from a patient‐ and outcome‐centered perspective, it is important to design studies where both HF and kidney end points are prespecified 44 , 45 ; this will allow cardiologists and nephrologists to collaborate to close gaps in the care of patients with HF and CKD. 45 , 46 …”

Section: Discussionmentioning

confidence: 99%

Changes in Doppler‐Derived Kidney Venous Flow and Adverse Cardiorenal Outcomes in Patients With Heart Failure

Husain‐Syed

Singam

Viehman

et al. 2023

JAHA

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Background The impact of changes in Doppler‐derived kidney venous flow in heart failure (HF) is not well studied. We aimed to investigate the association of Doppler‐derived kidney venous stasis index (KVSI) and intrakidney venous‐flow (IKVF) patterns with adverse cardiorenal outcomes in patients with HF. Methods and Results In this observational cohort study, consecutive inpatients with HF referred to a nephrologist because of a history of diuretic resistance and abnormal kidney function (n=216) underwent spectral kidney assessments after admission (Doppler 1) and 25 to 35 days later (Doppler 2) to identify IKVF patterns (continuous/pulsatile/biphasic/monophasic) and KVSI levels. Cox proportional hazard regression models were used to evaluate the associations between KVSI/IKVF patterns at Doppler 1 as well as changes from Doppler 1 to Doppler 2 and risk of cardiorenal events up to 18 months after admission. Worsening HF or death occurred in 126 patients. Both baseline KVSI (hazard ratio [HR], 1.49 [95% CI, 1.37–1.61] per 0.1‐unit increase) and baseline IKVF pattern (HR, 2.47 [95% CI, 2.01–3.04] per 1 pattern severity increase) were significantly associated with worsening HF/death. Increases in both KVSI and IKVF pattern severity from Doppler 1 to 2 were also associated with an increased risk of worsening HF/death (HR, 3.00 [95% CI, 2.08–4.32] per 0.1‐unit increase change; and HR, 6.73 [95% CI, 3.27–13.86] per 1 pattern increase in severity change, respectively). Similar results were observed for kidney outcomes. Conclusions Baseline kidney venous flow predicted adverse cardiorenal events, and inclusion of serial kidney venous flow in cardiorenal risk stratification could facilitate clinical decision‐making for patients with HF. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03039959.

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“…In 2004, Chertow et al (4) described the phenomenon of “renalism,” referring to the systematic exclusion of patients with CKD from cardiovascular trials of medical therapies and procedures due to a misconception of futility and/or harm. For example, in a systematic review of 706 RCTs for therapies in heart failure with reduced ejection fraction between 2010 and 2020, over a third of the trials had no information reported on kidney function (5). The number of trials that included patients with CKD was inversely related to eGFR, and patients on maintenance dialysis and kidney transplant recipients were included in <60 trials.…”

Section: Structural Inequitiesmentioning

confidence: 99%

Changing the Trajectory of Heart Failure and Kidney Disease

Rangaswami

Bhalla

Chertow

et al. 2022

CJASN

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Representation of Chronic Kidney Disease in Randomized Controlled Trials Among Patients With Heart failure With Reduced Ejection Fraction: A Systematic Review

Cited by 5 publications

References 24 publications

Stage 5 Chronic Kidney Disease: Epidemiological Analysis in a NorthEastern District of Italy Focusing on Access to Nephrological Care

Stage 5 Chronic Kidney Disease: Epidemiological Analysis in a NorthEastern District of Italy Focusing on Access to Nephrological Care

Changes in Doppler‐Derived Kidney Venous Flow and Adverse Cardiorenal Outcomes in Patients With Heart Failure

Changing the Trajectory of Heart Failure and Kidney Disease

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