Current and novel pharmacological approaches to renal insufficiency in heart failure.
Renal insufficiency is becoming an increasingly common and devastating comorbidity in both acute and chronic heart failure settings. Part of the problem is due to the lack of insight into the underlying pathophysiology of salt and water balance leading to the congestive states. This review summarizes our current understanding regarding the cause and consequences of renal insufficiency in patients with heart failure, and addresses some of the limitations of current therapeutic strategies. Based on these limitations, this paper will explore the ongoing efforts to develop novel drug therapeutics to prevent or ameliorate renal impairment in patients with heart failure. These include natriuretic peptides and other vasodilators, adenosine receptor antagonists, and vasopressin receptor antagonists all currently undergoing late-stage clinical trials.
Hindnavis
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Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH 44195, USA.
Tang
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WH
D000241:Adenosine / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D050034:Antidiuretic Agents / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists; D045283:Natriuretic Agents / Q000627:therapeutic use; D020097:Natriuretic Peptide, Brain / Q000627:therapeutic use; D045265:Natriuretic Peptides / Q000627:therapeutic use; D018377:Neurotransmitter Agents / Q000037:antagonists & inhibitors; D011379:Prognosis; D051437:Renal Insufficiency / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use; D014667:Vasopressins / Q000627:therapeutic use
D000806:Angiotensin-Converting Enzyme Inhibitors; D050034:Antidiuretic Agents; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists; D045283:Natriuretic Agents; D045265:Natriuretic Peptides; D018377:Neurotransmitter Agents; D014665:Vasodilator Agents; D014667:Vasopressins; D020097:Natriuretic Peptide, Brain; D000241:Adenosine