title: Current evidence on treatment of patients with chronic systolic heart failure and renal insufficiency: practical considerations from published data.
abstract: Chronic kidney disease (CKD) is increasingly prevalent in patients with chronic systolic heart failure. Therefore, evidence-based therapies are more and more being used in patients with some degree of renal dysfunction. However, most pivotal randomized clinical trials specifically excluded patients with (severe) renal dysfunction. The benefit of these evidence-based therapies in this high-risk patient group is largely unknown. This paper reviews data from randomized clinical trials in systolic heart failure and the interactions between baseline renal dysfunction and the effect of randomized treatment. It highlights that most evidence-based therapies show consistent outcome benefit in patients with moderate renal insufficiency (stage 3 CKD), whereas there are very scarce data on patients with severe (stage 4 to 5 CKD) renal insufficiency. If any, the outcome benefit might be even greater in stage 3 CKD compared with those with relatively preserved renal function. However, prescription of therapies should be individualized with consideration of possible harm and benefit, especially in those with stage 4 to 5 CKD where limited data are available.
authors: British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom; University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands. Electronic address: k.damman@umcg.nl.
authors: Kevin
authors: K
authors: Damman
authors: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors: W H Wilson
authors: WH
authors: Tang
authors: Duke Clinical Research Institute, Durham, North Carolina.
authors: G Michael
authors: GM
authors: Felker
authors: Department of Cardiology, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland.
authors: Johan
authors: J
authors: Lassus
authors: INSERM, Centre d'Investigation Clinique 9501 and Unité 961, Centre Hospitalier Universitaire, and the Department of Cardiology, Nancy University, Nancy, France.
authors: Faiez
authors: F
authors: Zannad
authors: Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia.
authors: Henry
authors: H
authors: Krum
authors: British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom.
authors: John J V
authors: JJ
authors: McMurray
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D058406:Cardiac Resynchronization Therapy / Q000379:methods; D004573:Electrolytes; D019317:Evidence-Based Medicine; D005919:Glomerular Filtration Rate; D054143:Heart Failure, Systolic / Q000150:complications* / Q000628:therapy*; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D051437:Renal Insufficiency / Q000150:complications* / Q000628:therapy*; D012084:Renin-Angiotensin System; D012306:Risk; D016896:Treatment Outcome
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D004573:Electrolytes; D000451:Mineralocorticoid Receptor Antagonists
keywords: evidence-based treatment; heart failure; pharmacological treatment; renal insufficiency