Effects of applying a standardised management algorithm for moderate to severe renal dysfunction in patients with chronic stable heart failure.
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.
de Silva
Ramesh
R
Department of Cardiology, University of Hull, Castle Hill Hospital, Kingston upon Hull, East Yorkshire, HU16 5JQ, United Kingdom. ramesh@desilva84.freeserve.co.uk
Nikitin
Nikolay P
NP
Witte
Klaus K A
KK
Rigby
Alan S
AS
Loh
Huan
H
Nicholson
Anthony
A
Bhandari
Sunil
S
Clark
Andrew L
AL
Cleland
John G F
JG
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
D000806:Angiotensin-Converting Enzyme Inhibitors; D000077144:Clopidogrel; D003404:Creatinine; D013988:Ticlopidine; D001241:Aspirin