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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Management of Heart Failure in Patients with Chronic Kidney Disease
David K Ryan1, Debasish Banerjee2,3, Fadi Jouhra3,4
1Clinical Pharmacology and Therapeutics, University College London Hospitals NHS Foundation Trust London, UK.
Insights
Heart failure (HF) and chronic kidney disease (CKD) often coexist. While some HF medications benefit early CKD, advanced CKD requires more research and integrated care from specialists.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Chronic kidney disease (CKD) is increasingly prevalent in heart failure (HF) patients, contributing significantly to morbidity and mortality.
- Established HF therapies like beta-blockers, RAASis, ARNIs, and MRAs show benefits in early-stage CKD (stages 1-3).
- Concerns regarding hyperkalemia and renal function decline often lead to suboptimal prescribing of ARNIs, RAASis, and MRAs in CKD patients.
Purpose of the Study:
- To review current evidence on managing HF in patients with CKD.
- To highlight the growing evidence for SGLT2 inhibitors and IV iron in HF with CKD.
- To identify gaps in knowledge regarding advanced CKD (stages 4-5) and dialysis populations.
Main Methods:
- Literature review of existing studies on HF and CKD management.
- Analysis of evidence for established and emerging therapies in different CKD stages.
- Emphasis on the need for interdisciplinary collaboration.
Main Results:
- Evidence supports beta-blockers, RAASis, ARNIs, and MRAs in early CKD stages (1-3).
- Sodium-glucose co-transporter 2 inhibitors and IV iron show promise for HF in CKD.
- Limited data exists for advanced CKD (stages 4-5) and dialysis patients regarding safety and efficacy of these therapies.
Conclusions:
- Integrated care involving HF and renal specialists is crucial for managing the growing population of patients with comorbid HF and CKD.
- Further research is needed to establish the safety and efficacy of HF therapies in advanced CKD and dialysis.
Abstract:
Chronic kidney disease (CKD) is increasingly prevalent in patients with heart failure (HF) and HF is one of the leading causes of hospitalisation, morbidity and mortality in patients with impaired renal function. Currently, there is strong evidence to support the symptomatic and prognostic benefits of β-blockers, renin-angiotensin-aldosterone inhibitors (RAASis), angiotensin receptor-neprilysin inhibitors (ARNIs) and mineralocorticoid receptor antagonists (MRA) in patients with HF and CKD stages 1-3. However, ARNIs, RAASis and MRAs are often suboptimally prescribed for patients with CKD owing to concerns about hyperkalaemia and worsening renal function. There is growing evidence for the use of sodium-glucose co-transporter 2 inhibitors and IV iron therapy in the management of HF in patients with CKD. However, few studies have included patients with CKD stages 4-5 and patients receiving dialysis, limiting the assessment of the safety and efficacy of these therapies in advanced CKD. Interdisciplinary input from HF and renal specialists is required to provide integrated care for the growing number of patients with HF and CKD.
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