Cargando…

The Treatment of Heart Failure in Patients with Chronic Kidney Disease: Doubts and New Developments from the Last ESC Guidelines

Patients with heart failure (HF) and associated chronic kidney disease (CKD) are a population less represented in clinical trials; additionally, subjects with more severe estimated glomerular filtration rate reduction are often excluded from large studies. In this setting, most of the data come from...

Descripción completa

Detalles Bibliográficos
Autores principales: Beltrami, Matteo, Milli, Massimo, Dei, Lorenzo Lupo, Palazzuoli, Alberto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9025648/
https://www.ncbi.nlm.nih.gov/pubmed/35456336
http://dx.doi.org/10.3390/jcm11082243
_version_ 1784690924777897984
author Beltrami, Matteo
Milli, Massimo
Dei, Lorenzo Lupo
Palazzuoli, Alberto
author_facet Beltrami, Matteo
Milli, Massimo
Dei, Lorenzo Lupo
Palazzuoli, Alberto
author_sort Beltrami, Matteo
collection PubMed
description Patients with heart failure (HF) and associated chronic kidney disease (CKD) are a population less represented in clinical trials; additionally, subjects with more severe estimated glomerular filtration rate reduction are often excluded from large studies. In this setting, most of the data come from post hoc analyses and retrospective studies. Accordingly, in patients with advanced CKD, there are no specific studies evaluating the long-term effects of the traditional drugs commonly administered in HF. Current concerns may affect the practical approach to the traditional treatment, and in this setting, physicians are often reluctant to administer and titrate some agents acting on the renin angiotensin aldosterone system and the sympathetic activity. Therefore, the extensive application in different HF subtypes with wide associated conditions and different renal dysfunction etiologies remains a subject of debate. The role of novel drugs, such as angiotensin receptor blocker neprilysin inhibitors and sodium glucose linked transporters 2 inhibitors seems to offer a new perspective in patients with CKD. Due to its protective vascular and hormonal actions, the use of these agents may be safely extended to patients with renal dysfunction in the long term. In this review, we discussed the largest trials reporting data on subjects with HF and associated CKD, while suggesting a practical stepwise algorithm to avoid renal and cardiac complications.
format Online
Article
Text
id pubmed-9025648
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-90256482022-04-23 The Treatment of Heart Failure in Patients with Chronic Kidney Disease: Doubts and New Developments from the Last ESC Guidelines Beltrami, Matteo Milli, Massimo Dei, Lorenzo Lupo Palazzuoli, Alberto J Clin Med Review Patients with heart failure (HF) and associated chronic kidney disease (CKD) are a population less represented in clinical trials; additionally, subjects with more severe estimated glomerular filtration rate reduction are often excluded from large studies. In this setting, most of the data come from post hoc analyses and retrospective studies. Accordingly, in patients with advanced CKD, there are no specific studies evaluating the long-term effects of the traditional drugs commonly administered in HF. Current concerns may affect the practical approach to the traditional treatment, and in this setting, physicians are often reluctant to administer and titrate some agents acting on the renin angiotensin aldosterone system and the sympathetic activity. Therefore, the extensive application in different HF subtypes with wide associated conditions and different renal dysfunction etiologies remains a subject of debate. The role of novel drugs, such as angiotensin receptor blocker neprilysin inhibitors and sodium glucose linked transporters 2 inhibitors seems to offer a new perspective in patients with CKD. Due to its protective vascular and hormonal actions, the use of these agents may be safely extended to patients with renal dysfunction in the long term. In this review, we discussed the largest trials reporting data on subjects with HF and associated CKD, while suggesting a practical stepwise algorithm to avoid renal and cardiac complications. MDPI 2022-04-17 /pmc/articles/PMC9025648/ /pubmed/35456336 http://dx.doi.org/10.3390/jcm11082243 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Beltrami, Matteo
Milli, Massimo
Dei, Lorenzo Lupo
Palazzuoli, Alberto
The Treatment of Heart Failure in Patients with Chronic Kidney Disease: Doubts and New Developments from the Last ESC Guidelines
title The Treatment of Heart Failure in Patients with Chronic Kidney Disease: Doubts and New Developments from the Last ESC Guidelines
title_full The Treatment of Heart Failure in Patients with Chronic Kidney Disease: Doubts and New Developments from the Last ESC Guidelines
title_fullStr The Treatment of Heart Failure in Patients with Chronic Kidney Disease: Doubts and New Developments from the Last ESC Guidelines
title_full_unstemmed The Treatment of Heart Failure in Patients with Chronic Kidney Disease: Doubts and New Developments from the Last ESC Guidelines
title_short The Treatment of Heart Failure in Patients with Chronic Kidney Disease: Doubts and New Developments from the Last ESC Guidelines
title_sort treatment of heart failure in patients with chronic kidney disease: doubts and new developments from the last esc guidelines
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9025648/
https://www.ncbi.nlm.nih.gov/pubmed/35456336
http://dx.doi.org/10.3390/jcm11082243
work_keys_str_mv AT beltramimatteo thetreatmentofheartfailureinpatientswithchronickidneydiseasedoubtsandnewdevelopmentsfromthelastescguidelines
AT millimassimo thetreatmentofheartfailureinpatientswithchronickidneydiseasedoubtsandnewdevelopmentsfromthelastescguidelines
AT deilorenzolupo thetreatmentofheartfailureinpatientswithchronickidneydiseasedoubtsandnewdevelopmentsfromthelastescguidelines
AT palazzuolialberto thetreatmentofheartfailureinpatientswithchronickidneydiseasedoubtsandnewdevelopmentsfromthelastescguidelines
AT beltramimatteo treatmentofheartfailureinpatientswithchronickidneydiseasedoubtsandnewdevelopmentsfromthelastescguidelines
AT millimassimo treatmentofheartfailureinpatientswithchronickidneydiseasedoubtsandnewdevelopmentsfromthelastescguidelines
AT deilorenzolupo treatmentofheartfailureinpatientswithchronickidneydiseasedoubtsandnewdevelopmentsfromthelastescguidelines
AT palazzuolialberto treatmentofheartfailureinpatientswithchronickidneydiseasedoubtsandnewdevelopmentsfromthelastescguidelines