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Management of Heart Failure Patient with CKD.

Banerjee, D; Rosano, G; Herzog, CA (2021) Management of Heart Failure Patient with CKD. Clin J Am Soc Nephrol, 16 (7). pp. 1131-1139. ISSN 1555-905X https://doi.org/10.2215/CJN.14180920
SGUL Authors: Rosano, Giuseppe Massimo Claudio Banerjee, Debasish

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Abstract

CKD is common in patients with heart failure, associated with high mortality and morbidity, which is even higher in people undergoing long-term dialysis. Despite increasing use of evidence-based drug and device therapy in patients with heart failure in the general population, patients with CKD have not benefitted. This review discusses prevalence and evidence of kidney replacement, device, and drug therapies for heart failure in CKD. Evidence for treatment with β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, angiotensin receptor neprilysin inhibitors, and sodium-glucose cotransporter inhibitors in mild-to-moderate CKD has emerged from general population studies in patients with heart failure with reduced ejection fraction (HFrEF). β-Blockers have been shown to improve outcomes in patients with HFrEF in all stages of CKD, including patients on dialysis. However, studies of HFrEF selected patients with creatinine <2.5 mg/dl for ACE inhibitors, <3.0 mg/dl for angiotensin-receptor blockers, and <2.5 mg/dl for mineralocorticoid receptor antagonists, excluding patients with severe CKD. Angiotensin receptor neprilysin inhibitor therapy was successfully used in randomized trials in patients with eGFR as low as 20 ml/min per 1.73 m2 Hence, the benefits of renin-angiotensin-aldosterone axis inhibitor therapy in patients with mild-to-moderate CKD have been demonstrated, yet such therapy is not used in all suitable patients because of fear of hyperkalemia and worsening kidney function. Sodium-glucose cotransporter inhibitor therapy improved mortality and hospitalization in patients with HFrEF and CKD stages 3 and 4 (eGFR>20 ml/min per 1.73 m2). High-dose and combination diuretic therapy, often necessary, may be complicated with worsening kidney function and electrolyte imbalances, but has been used successfully in patients with CKD stages 3 and 4. Intravenous iron improved symptoms in patients with heart failure and CKD stage 3; and high-dose iron reduced heart failure hospitalizations by 44% in patients on dialysis. Cardiac resynchronization therapy reduced death and hospitalizations in patients with heart failure and CKD stage 3. Peritoneal dialysis in patients with symptomatic fluid overload improved symptoms and prevented hospital admissions. Evidence suggests that combined cardiology-nephrology clinics may help improve management of patients with HFrEF and CKD. A multidisciplinary approach may be necessary for implementation of evidence-based therapy.

Item Type: Article
Additional Information: Management of Heart Failure Patient with CKD Debasish Banerjee, Giuseppe Rosano, Charles A. Herzog CJASN Jul 2021, 16 (7) 1131-1139; DOI: 10.2215/CJN.14180920
Keywords: chronic kidney disease, dialysis, heart failure, Urology & Nephrology, 1103 Clinical Sciences
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Clin J Am Soc Nephrol
ISSN: 1555-905X
Language: eng
Dates:
DateEvent
July 2021Published
25 January 2021Published Online
9 December 2020Accepted
Publisher License: Publisher's own licence
PubMed ID: 33495289
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/112912
Publisher's version: https://doi.org/10.2215/CJN.14180920

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