Jose Luis Górriz , Miguel González Rico , Julio Nuñez
{"title":"Tratamiento de la insuficiencia cardiaca en el paciente con insuficiencia renal avanzada","authors":"Jose Luis Górriz , Miguel González Rico , Julio Nuñez","doi":"10.1016/S1131-3587(20)30007-8","DOIUrl":null,"url":null,"abstract":"<div><p>Renal impairment is common in patients with heart failure (HF) and HF increases with decreasing estimated glomerular filtration. Furthermore, renal impairment has an impact on the prognosis in patients with HF. In general, recommendations for the treatment of patients with HF and concomitant chronic kidney disease (CKD) are not different from those for patients with normal renal function. However, patients with moderate- to-severe renal impairment have been excluded from most clinical trials, and evidence and safety data on the therapies to be used in such patients are scarce. In the present paper, existing evidences on currently available therapies for HF in patients with moderate-to-severe CKD, including ultrafiltration with peritoneal dialysis, are discussed. Therapy complications, such as hyperkalaemia and renal function impairment, are also described. Dual angiotensin receptor-neprilysin inhibitors appear promising as a therapy that could safely reduce the risk of HF among patients with CKD. Their benefit could be mediated, among other mechanisms, by their renal effects. Other therapies, such as sodium-glucose cotransporter-2 inhibitors, have proved beneficial in HF in diabetic patients showing various degrees of renal function.</p><p>Clinical trials are needed to obtain new evidence on the therapies for heart failure and to confidently reduce the excess risk of cardiovascular disease in renal disease.</p><p>Supplement information: this article is part of a supplement entitled \"Questions on a new era for heart failure treatment\" which is sponsored by Novartis</p></div>","PeriodicalId":34926,"journal":{"name":"Revista Espanola de Cardiologia Suplementos","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"2","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Revista Espanola de Cardiologia Suplementos","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1131358720300078","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 2
Abstract
Renal impairment is common in patients with heart failure (HF) and HF increases with decreasing estimated glomerular filtration. Furthermore, renal impairment has an impact on the prognosis in patients with HF. In general, recommendations for the treatment of patients with HF and concomitant chronic kidney disease (CKD) are not different from those for patients with normal renal function. However, patients with moderate- to-severe renal impairment have been excluded from most clinical trials, and evidence and safety data on the therapies to be used in such patients are scarce. In the present paper, existing evidences on currently available therapies for HF in patients with moderate-to-severe CKD, including ultrafiltration with peritoneal dialysis, are discussed. Therapy complications, such as hyperkalaemia and renal function impairment, are also described. Dual angiotensin receptor-neprilysin inhibitors appear promising as a therapy that could safely reduce the risk of HF among patients with CKD. Their benefit could be mediated, among other mechanisms, by their renal effects. Other therapies, such as sodium-glucose cotransporter-2 inhibitors, have proved beneficial in HF in diabetic patients showing various degrees of renal function.
Clinical trials are needed to obtain new evidence on the therapies for heart failure and to confidently reduce the excess risk of cardiovascular disease in renal disease.
Supplement information: this article is part of a supplement entitled "Questions on a new era for heart failure treatment" which is sponsored by Novartis
期刊介绍:
Revista Española de Cardiología, is an international scientific journal dealing with cardiovascular medicine. Revista Española de Cardiología, the official publication of the Spanish Society of Cardiology, publishes research articles related to cardiovascular diseases. Articles are published in Spanish for the paper edition and in both Spanish and English in the electronic edition, which is available on the Internet. Regular sections include original articles reporting clinical or basic research, brief reports, review articles, editorials and letters to the Editor.