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Heart failure in patients with chronic kidney disease: a systematic integrative review
Liviu Segall1, Ionut Nistor1, Adrian Covic1
1Nephrology Department, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", Strada. Universităţii No. 16, 700115 Iaşi, Romania.
Insights
Treating heart failure (HF) in chronic kidney disease (CKD) patients requires managing fluid overload and optimizing medications like beta-blockers. Dialysis adjustments are also key for better outcomes in these high-risk individuals.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Heart failure (HF) is common in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients, significantly increasing mortality risk.
- Current HF treatment strategies for CKD/ESRD patients remain largely undefined.
Purpose of the Study:
- To systematically review existing literature on heart failure treatment in patients with chronic kidney disease.
- To synthesize current evidence regarding effective HF management in this vulnerable population.
Main Methods:
- A systematic integrative literature review was performed, searching electronic databases in April 2014.
- Included studies of any design focusing on adult CKD patients with a primary HF diagnosis.
- Narrative synthesis methods were employed to analyze findings.
Main Results:
- 79 articles met inclusion criteria from database searches, with an additional 23 identified through hand searching.
- The review encompassed various measures of HF treatment efficacy.
Conclusions:
- Key treatments for HF in CKD/ESRD include fluid overload control, beta-blockers, ACE inhibitors/ARBs, and optimized dialysis.
- Aldosterone antagonists and digitalis glycosides may be considered but carry risks.
- Anemia, CKD-mineral bone disorder, and cardiac resynchronization therapy roles are also discussed.
Introduction:
Heart failure (HF) is highly prevalent in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) and is strongly associated with mortality in these patients. However, the treatment of HF in this population is largely unclear.
Study Design:
We conducted a systematic integrative review of the literature to assess the current evidence of HF treatment in CKD patients, searching electronic databases in April 2014. Synthesis used narrative methods.
Setting And Population:
We focused on adults with a primary diagnosis of CKD and HF.
Selection Criteria For Studies:
We included studies of any design, quantitative or qualitative.
Interventions:
HF treatment was defined as any formal means taken to improve the symptoms of HF and/or the heart structure and function abnormalities.
Outcomes:
Measures of all kinds were considered of interest.
Results:
Of 1,439 results returned by database searches, 79 articles met inclusion criteria. A further 23 relevant articles were identified by hand searching.
Conclusions:
Control of fluid overload, the use of beta-blockers and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and optimization of dialysis appear to be the most important methods to treat HF in CKD and ESRD patients. Aldosterone antagonists and digitalis glycosides may additionally be considered; however, their use is associated with significant risks. The role of anemia correction, control of CKD-mineral and bone disorder, and cardiac resynchronization therapy are also discussed.
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