Author + information
- Received January 27, 2019
- Accepted February 20, 2019
- Published online April 29, 2019.
- Aaron M. Hein, BSa,
- Julia J. Scialla, MD, MHSa,b,
- Daniel Edmonston, MDa,b,
- Lauren B. Cooper, MD, MHSa,c,
- Adam D. DeVore, MD, MHSa,b and
- Robert J. Mentz, MDa,b,∗ ()
- aDepartment of Medicine, Duke University School of Medicine, Durham, North Carolina
- bDuke Clinical Research Institute, Durham, North Carolina
- cInova Heart and Vascular Institute, Falls Church, Virginia
- ↵∗Address for correspondence:
Dr. Robert J. Mentz, Duke Clinical Research Institute, 2301 Erwin Road, P.O. Box 17969, Durham, North Carolina 27715.
• Patients with HF and advanced chronic kidney disease constitute a substantial population that experiences poor outcomes.
• Evidence for HF therapies in this population is limited by study exclusion and nonstandard definitions.
• Renin-angiotensin system inhibitors and beta-blockers have yielded some promising results, whereas mineralocorticoid receptor antagonists should generally be avoided.
• Directed trials and well-powered studies are needed to examine the potential risk-benefit balance of HF therapies.
Large randomized clinical trials (RCT) supporting guidelines for the management of heart failure with reduced ejection fraction (HFrEF) have typically excluded patients with advanced chronic kidney disease (CKD). Patients with concomitant advanced CKD and HFrEF experience poor cardiovascular outcomes and mortality relative to either disease in isolation and have been shown to consistently receive lower rates of HFrEF guideline-directed medical therapy (GDMT). This review evaluated recent evidence for the use of GDMT in patients with HFrEF and advanced CKD approaching dialysis from RCTs and observational cohorts. The authors also discuss the limitations and challenges inherent in the evidence for GDMT in this population, and offer guidance to clinicians for proper clinical use and future research directions.
Dr. Scialla has received research support from National Institute of Diabetes and Digestive and Kidney Diseases grant R01DK111952, GlaxoSmithKline, and Sanofi. Dr. Cooper has received research support from Abbott Laboratories. Dr. DeVore has received research support from Amgen, the American Heart Association, the National Heart, Lung, and Blood Institute, and Novartis; and is a consultant for Novartis. Dr. Mentz has received research support from National Institutes of Health grants U01HL125511-01A1, U10HL110312, and R01AG045551-01A1; has received funding from Akros, Amgen, AstraZeneca, Bayer, GlaxoSmithKline, Gilead, Luitpold, Medtronic, Merck Sharp & Dohme, Novartis, Otsuka, and ResMed; has received honoraria from Abbott Laboratory, Amgen, AstraZeneca, Bayer, Janssen, Luitpold Pharmaceuticals, Medtronic, Merck Sharp & Dohme, Novartis, and ResMed; and serves on advisory boards for Amgen, Luitpold, Merck Sharp & Dohme, and Boehringer Ingelheim. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Barry Greenberg, MD, served as Guest Editor for this paper.
- Received January 27, 2019.
- Accepted February 20, 2019.
- 2019 American College of Cardiology Foundation
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