Current evidence on treatment of patients with chronic systolic heart failure and renal insufficiency: practical considerations from published data

Kevin Damman, Wai Hong Wilson Tang, Gary Michael Felker, Johan Lassus, Faiez Zannad, Henry Krum, John J V McMurray

Research output: Contribution to journalArticleResearchpeer-review

55 Citations (Scopus)

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
Original languageEnglish
Pages (from-to)853 - 871
Number of pages19
JournalJournal of the American College of Cardiology
Volume63
Issue number9
DOIs
Publication statusPublished - 2014

Cite this

Damman, Kevin ; Wilson Tang, Wai Hong ; Felker, Gary Michael ; Lassus, Johan ; Zannad, Faiez ; Krum, Henry ; McMurray, John J V. / Current evidence on treatment of patients with chronic systolic heart failure and renal insufficiency: practical considerations from published data. In: Journal of the American College of Cardiology. 2014 ; Vol. 63, No. 9. pp. 853 - 871.
@article{58e3292627374bf0b26dbb89acefb20f,
title = "Current evidence on treatment of patients with chronic systolic heart failure and renal insufficiency: practical considerations from published data",
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",
author = "Kevin Damman and {Wilson Tang}, {Wai Hong} and Felker, {Gary Michael} and Johan Lassus and Faiez Zannad and Henry Krum and McMurray, {John J V}",
year = "2014",
doi = "10.1016/j.jacc.2013.11.031",
language = "English",
volume = "63",
pages = "853 -- 871",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier",
number = "9",

}

Current evidence on treatment of patients with chronic systolic heart failure and renal insufficiency: practical considerations from published data. / Damman, Kevin; Wilson Tang, Wai Hong; Felker, Gary Michael; Lassus, Johan; Zannad, Faiez; Krum, Henry; McMurray, John J V.

In: Journal of the American College of Cardiology, Vol. 63, No. 9, 2014, p. 853 - 871.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Current evidence on treatment of patients with chronic systolic heart failure and renal insufficiency: practical considerations from published data

AU - Damman, Kevin

AU - Wilson Tang, Wai Hong

AU - Felker, Gary Michael

AU - Lassus, Johan

AU - Zannad, Faiez

AU - Krum, Henry

AU - McMurray, John J V

PY - 2014

Y1 - 2014

N2 - 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

AB - 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

UR - http://www.sciencedirect.com/science/article/pii/S0735109713064255#

U2 - 10.1016/j.jacc.2013.11.031

DO - 10.1016/j.jacc.2013.11.031

M3 - Article

VL - 63

SP - 853

EP - 871

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 9

ER -