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Current evidence on treatment of patients with chronic systolic heart failure and renal insufficiency: practical

Kevin Damman1, W H Wilson Tang2, G Michael Felker3

  • 1British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom; University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands.

Journal of the American College of Cardiology
|December 17, 2013
PubMed

Insights

Evidence-based heart failure therapies benefit patients with moderate chronic kidney disease (CKD). Data is limited for severe CKD, necessitating individualized treatment decisions for this high-risk group.

Area of Science:

  • Cardiology
  • Nephrology
  • Clinical Trials

Background:

  • Chronic kidney disease (CKD) prevalence is rising in patients with chronic systolic heart failure.
  • Evidence-based therapies are increasingly used in patients with renal dysfunction, but trial data often excludes these individuals.
  • The efficacy of standard heart failure treatments in patients with impaired renal function remains largely uncharacterized.

Purpose of the Study:

  • To review data from randomized clinical trials in systolic heart failure.
  • To examine the interaction between baseline renal dysfunction and treatment effects.
  • To assess the benefit of evidence-based therapies in patients with varying degrees of CKD.

Main Methods:

  • Systematic review of pivotal randomized clinical trials in systolic heart failure.
  • Analysis of treatment effects stratified by baseline renal function (CKD stages).
  • Evaluation of outcome data in relation to renal insufficiency.

Main Results:

  • Most evidence-based therapies demonstrate consistent benefits in patients with moderate renal insufficiency (Stage 3 CKD).
  • Data on treatment benefits for severe renal insufficiency (Stage 4-5 CKD) are scarce.
  • Potential for greater outcome benefit in Stage 3 CKD compared to preserved renal function.

Conclusions:

  • Evidence-based heart failure therapies are beneficial for patients with moderate CKD.
  • Limited data exist for severe CKD, requiring careful, individualized treatment consideration.
  • Further research is needed to clarify treatment benefits and risks in advanced CKD.

Keywords:
evidence-based treatmentheart failurepharmacological treatmentrenal insufficiency

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