The Treatment of Heart Failure in Patients with Chronic Kidney Disease: Doubts and New Developments from the Last ESC Guidelines
Patients with heart failure (HF) and associated chronic kidney disease (CKD) are a population less represented in clinical trials; additionally, subjects with more severe estimated glomerular filtration rate reduction are often excluded from large studies. In this setting, most of the data come from...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-04-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/8/2243 |
| _version_ | 1797410617007538176 |
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| author | Matteo Beltrami Massimo Milli Lorenzo Lupo Dei Alberto Palazzuoli |
| author_facet | Matteo Beltrami Massimo Milli Lorenzo Lupo Dei Alberto Palazzuoli |
| author_sort | Matteo Beltrami |
| collection | DOAJ |
| description | Patients with heart failure (HF) and associated chronic kidney disease (CKD) are a population less represented in clinical trials; additionally, subjects with more severe estimated glomerular filtration rate reduction are often excluded from large studies. In this setting, most of the data come from post hoc analyses and retrospective studies. Accordingly, in patients with advanced CKD, there are no specific studies evaluating the long-term effects of the traditional drugs commonly administered in HF. Current concerns may affect the practical approach to the traditional treatment, and in this setting, physicians are often reluctant to administer and titrate some agents acting on the renin angiotensin aldosterone system and the sympathetic activity. Therefore, the extensive application in different HF subtypes with wide associated conditions and different renal dysfunction etiologies remains a subject of debate. The role of novel drugs, such as angiotensin receptor blocker neprilysin inhibitors and sodium glucose linked transporters 2 inhibitors seems to offer a new perspective in patients with CKD. Due to its protective vascular and hormonal actions, the use of these agents may be safely extended to patients with renal dysfunction in the long term. In this review, we discussed the largest trials reporting data on subjects with HF and associated CKD, while suggesting a practical stepwise algorithm to avoid renal and cardiac complications. |
| first_indexed | 2024-03-09T04:32:46Z |
| format | Article |
| id | doaj.art-454ce4ae63f64a7c80dc4efa8399a4bd |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T04:32:46Z |
| publishDate | 2022-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-454ce4ae63f64a7c80dc4efa8399a4bd2023-12-03T13:33:09ZengMDPI AGJournal of Clinical Medicine2077-03832022-04-01118224310.3390/jcm11082243The Treatment of Heart Failure in Patients with Chronic Kidney Disease: Doubts and New Developments from the Last ESC GuidelinesMatteo Beltrami0Massimo Milli1Lorenzo Lupo Dei2Alberto Palazzuoli3Cardiology Unit, San Giovanni di Dio Hospital, Via Torregalli 3, 50142 Florence, ItalyCardiology Unit, San Giovanni di Dio Hospital, Via Torregalli 3, 50142 Florence, ItalyCardiology, Department of Life, Health and Enviromental Sciences, University of L’Aquila, 67100 L’Aquila, ItalyCardiovascular Diseases Unit, Cardio Thoracic and Vascular Department, Le Scotte Hospital, University of Siena, 53100 Siena, ItalyPatients with heart failure (HF) and associated chronic kidney disease (CKD) are a population less represented in clinical trials; additionally, subjects with more severe estimated glomerular filtration rate reduction are often excluded from large studies. In this setting, most of the data come from post hoc analyses and retrospective studies. Accordingly, in patients with advanced CKD, there are no specific studies evaluating the long-term effects of the traditional drugs commonly administered in HF. Current concerns may affect the practical approach to the traditional treatment, and in this setting, physicians are often reluctant to administer and titrate some agents acting on the renin angiotensin aldosterone system and the sympathetic activity. Therefore, the extensive application in different HF subtypes with wide associated conditions and different renal dysfunction etiologies remains a subject of debate. The role of novel drugs, such as angiotensin receptor blocker neprilysin inhibitors and sodium glucose linked transporters 2 inhibitors seems to offer a new perspective in patients with CKD. Due to its protective vascular and hormonal actions, the use of these agents may be safely extended to patients with renal dysfunction in the long term. In this review, we discussed the largest trials reporting data on subjects with HF and associated CKD, while suggesting a practical stepwise algorithm to avoid renal and cardiac complications.https://www.mdpi.com/2077-0383/11/8/2243heart failurechronic kidney diseaseestimated glomerular filtration ratesodium glucose linked transporters 2 inhibitorstreatmentangiotensin receptor blocker neprilysin inhibitors |
| spellingShingle | Matteo Beltrami Massimo Milli Lorenzo Lupo Dei Alberto Palazzuoli The Treatment of Heart Failure in Patients with Chronic Kidney Disease: Doubts and New Developments from the Last ESC Guidelines Journal of Clinical Medicine heart failure chronic kidney disease estimated glomerular filtration rate sodium glucose linked transporters 2 inhibitors treatment angiotensin receptor blocker neprilysin inhibitors |
| title | The Treatment of Heart Failure in Patients with Chronic Kidney Disease: Doubts and New Developments from the Last ESC Guidelines |
| title_full | The Treatment of Heart Failure in Patients with Chronic Kidney Disease: Doubts and New Developments from the Last ESC Guidelines |
| title_fullStr | The Treatment of Heart Failure in Patients with Chronic Kidney Disease: Doubts and New Developments from the Last ESC Guidelines |
| title_full_unstemmed | The Treatment of Heart Failure in Patients with Chronic Kidney Disease: Doubts and New Developments from the Last ESC Guidelines |
| title_short | The Treatment of Heart Failure in Patients with Chronic Kidney Disease: Doubts and New Developments from the Last ESC Guidelines |
| title_sort | treatment of heart failure in patients with chronic kidney disease doubts and new developments from the last esc guidelines |
| topic | heart failure chronic kidney disease estimated glomerular filtration rate sodium glucose linked transporters 2 inhibitors treatment angiotensin receptor blocker neprilysin inhibitors |
| url | https://www.mdpi.com/2077-0383/11/8/2243 |
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