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[Pharmacologic treatment of heart failure with reduced ejection fraction in chronic kidney disease]
Gunnar Henrik Heine1, Kyrill Sebastian Rogacev2,3
1AGAPLESION MARKUS KRANKENHAUS, Medizinische Klinik II, Frankfurt am Main.
Insights
Managing Heart Failure with reduced Ejection Fraction (HFrEF) and chronic kidney disease (CKD) is challenging. Careful monitoring allows safe use of traditional therapies, while new drugs like SGLT2 inhibitors show promise for these complex patients.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Co-existing Heart Failure with reduced Ejection Fraction (HFrEF) and chronic kidney disease (CKD) presents management difficulties.
- Traditional HFrEF therapies were tested in trials excluding patients with significant CKD.
- Renin-angiotensin-aldosterone system inhibitors risk renal function decline and hyperkalemia in CKD patients.
Purpose of the Study:
- To review the challenges and therapeutic strategies for HFrEF patients with co-existing CKD.
- To highlight the safety and efficacy of established and emerging pharmacologic treatments.
Main Methods:
- Review of clinical trial data and established treatment guidelines.
- Analysis of safety profiles for traditional and novel HFrEF medications in CKD populations.
- Exploration of emerging therapeutic agents, including SGLT2 inhibitors and Sacubitril/Valsartan.
Main Results:
- Established HFrEF pharmacotherapies can be safely administered to CKD patients with careful monitoring.
- Iron supplementation is a well-established treatment for anemia in CKD.
- Sodium-glucose cotransporter 2 (SGLT2) inhibitors demonstrate promising efficacy in both HFrEF and CKD.
- Sacubitril/Valsartan has shown significant event reduction in HFrEF and potential renal benefits.
Conclusions:
- Optimizing medical management for HFrEF patients with CKD requires careful consideration of therapeutic risks and benefits.
- Close monitoring facilitates the safe use of guideline-directed medical therapy in this population.
- Novel agents like SGLT2 inhibitors and Sacubitril/Valsartan represent important advancements in treating comorbid HFrEF and CKD.
Abstract:
Medical management of patients with co-existing Heart Failure with reduced Ejection Fraction (HFrEF) and chronic kidney disease (CKD) poses a significant challenge to treating physicians. On the one hand, the traditional therapeutic strategies such as betablockers, angiotensin converting enzyme inhibiotors, angiotensin receptor blockers and mineralocorticoid receptor antagonists have been evaluated in clinical trials that broadly excluded patients with significant CKD. On the other hand, inhibition of the renin angiotensin aldosterone system can lead to worsening of renal function and hyperkalemia potentially causing harm. Consequently, the cornerstones of heart failure treatment are often not adequately employed in HFrEF patients with CKD, a fact which is in itself a risk factor for worse outcomes in this patient population. Notably, it has been shown that these established pharmacologic strategies can be safely administered when carefully monitored. Iron treatment in anemia in CKD is well established and outcome trials in HFrEF are underway. New therapeutic strategies are under current investigation. Sodium glucose transporter 2 inhibitors show promising results in HFrEF and in CKD trials. In addition, Sacubitril/Valsartan significantly reduced events in HFrEF and might reduce renal events in HFpEF.
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