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Current evidence on treatment of patients with chronic systolic heart failure and renal insufficiency: Practical considerations from published data
Damman, Kevin Tang, W. H. Wilson Felker, G. Michael Lassus, Johan Zannad, Faiez Krum, Henry McMurray, John J.V.
Damman, Kevin
Tang, W. H. Wilson
Felker, G. Michael
Lassus, Johan
Zannad, Faiez
Krum, Henry
McMurray, John J.V.
Abstract
Chronic kidney disease (CKD) is increasingly prevalent in patients with chronic systolic heart failure. Therefore, evidence-based therapies are more and more being used in patients with some degree of renal dysfunction. However, most pivotal randomized clinical trials specifically excluded patients with (severe) renal dysfunction. The benefit of these evidence-based therapies in this high-risk patient group is largely unknown. This paper reviews data from randomized clinical trials in systolic heart failure and the interactions between baseline renal dysfunction and the effect of randomized treatment. It highlights that most evidence-based therapies show consistent outcome benefit in patients with moderate renal insufficiency (stage 3 CKD), whereas there are very scarce data on patients with severe (stage 4 to 5 CKD) renal insufficiency. If any, the outcome benefit might be even greater in stage 3 CKD compared with those with relatively preserved renal function. However, prescription of therapies should be individualized with consideration of possible harm and benefit, especially in those with stage 4 to 5 CKD where limited data are available. (J Am Coll Cardiol 2014;63:853–71) ª 2014 by the American College of Cardiology Foundation
Keywords
evidence-based treatment, heart failure, pharmacological treatment, renal insufficiency
Date
2014
Type
Journal article
Journal
Journal of the American College of Cardiology
Book
Volume
63
Issue
9
Page Range
853-871
Article Number
ACU Department
Collections
Relation URI
Source URL
Event URL
Open Access Status
Open access
License
File Access
Controlled