Current Evidence on Treatment of Patients With Chronic Systolic Heart Failure and Renal Insufficiency

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:63

Article

Damman, Kevin^1,2  Tang, W. H. Wilson³  Felker, G. Michael⁴  Lassus, Johan⁵  Zannad, Faiez^6,7,8  Krum, Henry⁹  McMurray, John J. V.¹ 

[1] Univ Glasgow, British Heart Fdn Cardiovasc Res Ctr, Glasgow, Lanark, Scotland

[2] Univ Groningen, Univ Med Ctr Groningen, Dept Cardiol, Groningen, Netherlands

[3] Cleveland Clin, Inst Heart & Vasc, Cleveland, OH 44106 USA

[4] Duke Clin Res Inst, Durham, NC USA

[5] Univ Helsinki, Cent Hosp, Heart & Lung Ctr, Dept Cardiol, Helsinki, Finland

[6] Nancy Univ, INSERM, Ctr Invest Clin 9501, Nancy, France

[7] Nancy Univ, Ctr Hosp Univ, Unite 961, Nancy, France

[8] Nancy Univ, Dept Cardiol, Nancy, France

[9] Monash Univ, Ctr Cardiovasc Res & Educ Therapeut, Dept Epidemiol & Prevent Med, Melbourne, Vic 3004, Australia

关键词: evidence-based treatment;    heart failure;    pharmacological treatment;    renal insufficiency;   

DOI  :  10.1016/j.jacc.2013.11.031

来源: Elsevier

【 摘 要 】

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. (C) 2014 by the American College of Cardiology Foundation

【 授权许可】

Free