Renal dysfunction in heart failure patients: what is the evidence?
Congestive heart failure (CHF) is an increasingly common medical condition and the fastest growing cardiovascular diagnosis in North America. Over one-third of patients with heart failure also have renal insufficiency. It has been shown that renal insufficiency confers worsened outcomes to patients with heart failure. However, a majority of the larger and therapy-defining heart failure medication and device trials exclude patients with advanced renal dysfunction. These studies also infrequently perform subgroup analyses based on the degree of renal dysfunction. The lack of information on heart failure patients who have renal insufficiency likely contributes to their being prescribed mortality and morbidity reducing medications and receiving diagnostic and therapeutic procedures at lower rates than heart failure patients with normal renal function. Inclusion of patients with renal insufficiency in heart failure studies and published guidelines for medication, device, and interventional therapies would likely improve patient outcomes.
Saltzman
Heath E
HE
Department of Medicine, Jefferson Medical College, Jefferson Heart Institute, Thomas Jefferson University, 925 Chestnut Street, #135, Mezzanine Level, Philadelphia, PA 19107, USA.
Sharma
Kumar
K
Mather
Paul J
PJ
Rubin
Sharon
S
Adams
Suzanne
S
Whellan
David Joshua
DJ
D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D006328:Cardiac Catheterization / Q000009:adverse effects; D002304:Cardiac Pacing, Artificial; D002986:Clinical Trials as Topic; D004077:Digoxin / Q000627:therapeutic use; D006333:Heart Failure / Q000150:complications* / Q000188:drug therapy* / Q000628:therapy; D006801:Humans; D020105:Milrinone / Q000627:therapeutic use; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D020097:Natriuretic Peptide, Brain / Q000627:therapeutic use; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000188:drug therapy* / Q000628:therapy; D016896:Treatment Outcome; D014462:Ultrafiltration
D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists; D020097:Natriuretic Peptide, Brain; D004077:Digoxin; D020105:Milrinone