Cardiorenal Crosstalk in Patients with Heart Failure
Abstract
:1. Introduction
2. Chronic Kidney Disease in Heart Failure—The Real-World Data
3. Definition of Worsening Kidney Function
4. Antagonists of the Renin–Angiotensin–Aldosterone System (RAAS)
4.1. Angiotensin Receptor Blockers (ARBs)
4.1.1. ARB in HFrEF with Kidney Dysfunction
4.1.2. ARB in HFpEF with Kidney Dysfunction
4.2. Angiotensin-Converting Enzyme Inhibitors (ACEIs)
4.2.1. ACEI in HFrEF with Kidney Dysfunction
4.2.2. ACEI in HFpEF with Kidney Dysfunction
4.2.3. ACEI in Diabetic Kidney Disease
4.3. Angiotensin Receptor–Neprilysin Inhibitor (ARNI)
4.3.1. ARNI in HFrEF with Kidney Dysfunction
4.3.2. ARNI in HFpEF with Kidney Dysfunction
4.3.3. ARNI in Diabetic Kidney Dysfunction
4.4. Mineralocorticoid Receptor Antagonist (MRA)
4.4.1. MRA in HFrEF with Kidney Dysfunction
4.4.2. MRA in HFpEF with Kidney Dysfunction
4.4.3. MRA in Diabetic Kidney Dysfunction
5. Overall Consideration of RAAS Antagonists
6. Beta-Blockers in HFrEF with Kidney Dysfunction
7. Sodium–Glucose Cotransporter 2 Inhibitors (SGLT2)
7.1. SGLT2 Inhibition in HFrEF Patients with Kidney Dysfunction
7.2. SGLT2 Inhibition in HFpEF Patients with Kidney Dysfunction
7.3. SGLT2 Inhibition in Patients with Diabetic Kidney Dysfunction
8. Non-Pharmacological Treatment Options
8.1. Ultrafiltration
8.2. MitraClip Placement in HFrEF Patients with Kidney Dysfunction
8.3. Tricuspid Clip
9. Long-Term Mechanical Circulatory Systems (LT-MCSs)
10. Orthotopic Heart Transplantation
11. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
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Drug Class | Medical Therapy | Target Daily Dose in Heart Failure Clinical Trials | Drug Dose Recommendations in Advanced CKD |
---|---|---|---|
ACE inhibitors (ACEis) | Enalapril | 20 mg BD | Maximum dose of 5 mg D for enalapril |
Lisinopril | 50 mg D | Maximum dose of 5 mg D for lisinopril | |
Captopril | 75 mg BD | Maximum dose of 6.25 mg D for captopril | |
Angiotensin II Receptor Blockers (ARBs) | Candesartan | 32 mg D | Candesartan untested in eGFR < 15 mL/min |
Valsartan | 160 mg BD | Valsartan untested in eGFR < 10 mL/min | |
Angiotensin Receptor–Neprilysin Inhibitor (ARNI) | Sacubritril/Valsartan | 200 mg BD | No adjustment recommended |
Steroidal Mineralocorticoid receptor Antagonist (MRA) | Spironolactone | 50 mg D | Contraindicated with eGFR < 30 mL/min |
Eplerenone | 50 mg D | Contraindicated with eGFR < 30 mL/min | |
Nonsteroidal Mineralocorticoid Antagonist | Finerenon | 10 mg D | Not recommended with eGFR < 25 mL/min |
Beta-blockers | Carvedilol | 50 mg BD | No adjustment recommended for carvedilol, cardvedilol, or bisoprolol |
Bisoprolol | 10 mg D | ||
Metoprolol | 200 mg D | ||
Sodium–glucose cotransporter-2 inhibitor (SGLT2i) | Dapaglifozin | 10 mg D | No adjustment recommended |
Empaglifozin | 10 mg D | Not recommended with eGFR < 20 mL/min (results of the EMPA-Kidney pending) | |
Practice guidelines recommend up-titration of evidence-based medications at trial doses for all HF patients, as tolerated. Close monitoring of blood pressure, serum potassium and kidney function is recommended |
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Schukraft, S.; Hullin, R. Cardiorenal Crosstalk in Patients with Heart Failure. Kidney Dial. 2022, 2, 369-385. https://doi.org/10.3390/kidneydial2030033
Schukraft S, Hullin R. Cardiorenal Crosstalk in Patients with Heart Failure. Kidney and Dialysis. 2022; 2(3):369-385. https://doi.org/10.3390/kidneydial2030033
Chicago/Turabian StyleSchukraft, Sara, and Roger Hullin. 2022. "Cardiorenal Crosstalk in Patients with Heart Failure" Kidney and Dialysis 2, no. 3: 369-385. https://doi.org/10.3390/kidneydial2030033
APA StyleSchukraft, S., & Hullin, R. (2022). Cardiorenal Crosstalk in Patients with Heart Failure. Kidney and Dialysis, 2(3), 369-385. https://doi.org/10.3390/kidneydial2030033