title: Effects of applying a standardised management algorithm for moderate to severe renal dysfunction in patients with chronic stable heart failure.
abstract: BACKGROUND
  No specific guidelines exist on how to manage renal dysfunction (RD) in patients with chronic heart failure (CHF).
  
  
  OBJECTIVE
  To identify the proportion of patients with moderate to severe RD and CHF who showed an improvement in their renal function in response to a systematic management algorithm.
  
  
  METHODS
  Stable patients with CHF and RD (defined by a serum creatinine (SCr) of >130 micromol/l (>1.5 mg/dl)) were enrolled into a systematic management algorithm. The following changes were implemented: switching aspirin to clopidogrel, halving the dose of both diuretics and angiotensin converting enzyme (ACE) inhibitors and switching between bisoprolol and carvedilol.
  
  
  RESULTS
  Two thirds of patients in whom diuretics were reduced, and one fifth of patients in whom ACE inhibitors were reduced, improved their SCr by >25.5 micromol/l (0.3 mg/dl). All these changes were more marked in the presence of bilateral renal artery stenosis. Compared to a reference group, in whom no changes were implemented, the treatment group showed an improvement in their mean SCr by 35 micromol/l (0.4 mg/dl), p<0.001.
  
  
  CONCLUSIONS
  Manipulation of pharmacological therapy for patients with CHF and RD results in a substantial recovery of renal function in a minority of patients.
authors.affiliation: Department of Cardiology, University of Hull, Castle Hill Hospital, Kingston upon Hull, East Yorkshire, HU16 5JQ, United Kingdom. ramesh@desilva84.freeserve.co.uk
authors.forename: Ramesh
authors.initials: R
authors.lastname: de Silva
authors.forename: Nikolay P
authors.initials: NP
authors.lastname: Nikitin
authors.forename: Klaus K A
authors.initials: KK
authors.lastname: Witte
authors.forename: Alan S
authors.initials: AS
authors.lastname: Rigby
authors.forename: Huan
authors.initials: H
authors.lastname: Loh
authors.forename: Anthony
authors.initials: A
authors.lastname: Nicholson
authors.forename: Sunil
authors.initials: S
authors.lastname: Bhandari
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Clark
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
mesh_terms: D000368:Aged; D000465:Algorithms; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D003404:Creatinine / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology*; D018810:Magnetic Resonance Angiography; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012078:Renal Artery Obstruction / Q000209:etiology*; D012307:Risk Factors; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000077144:Clopidogrel; D003404:Creatinine; D013988:Ticlopidine; D001241:Aspirin