Challenges and Opportunities in Titrating Disease-Modifying Therapies in Heart Failure with Reduced Ejection Fraction and Chronic Kidney Disease.

IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Stefana Enachi, Maxime Schleef, Chahr-Eddine Hadjseyd, Simon Leboube, Charles Fauvel, Lucie Daniel, Antoine Jobbe-Duval, Laurent Sebbag, Sandrine Lemoine, Nathan Mewton
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引用次数: 0

Abstract

Purpose of review: Chronic kidney disease (CKD) is highly prevalent in patients with heart failure and reduced ejection fraction (HFrEF), representing a major factor of adverse outcomes. In clinical practice, it is one of the main reasons for not initiating, not titrating, and even withdrawing efficient heart failure drug therapies in patients.

Recent findings: Despite limited data, studies show that HFrEF therapies maintain their benefits on cardiovascular outcomes in patients with CKD. Most HF drugs cause acute renal haemodynamic changes, but with stabilisation or even improvement after the acute phase, thus with no long-term worsening of the renal function. In this expert opinion-based paper, we challenge the pathophysiology misunderstandings that impede HF disease-modifying therapy implementation in this setting and propose a strategy for HF drug titration in patients with moderate, severe, and end-stage chronic kidney disease.

心力衰竭伴射血分数降低和慢性肾脏疾病的疾病修饰疗法滴定的挑战和机遇。
综述目的:慢性肾脏疾病(CKD)在心力衰竭和射血分数降低(HFrEF)患者中非常普遍,是不良结局的主要因素。在临床实践中,这是患者不启动、不滴定甚至撤销有效心力衰竭药物治疗的主要原因之一。最新发现:尽管数据有限,但研究表明,HFrEF治疗对CKD患者的心血管预后仍有益处。大多数心衰药物引起急性肾血流动力学改变,但在急性期后稳定甚至改善,因此没有肾功能的长期恶化。在这篇基于专家意见的论文中,我们挑战了在这种情况下阻碍HF疾病改善治疗实施的病理生理学误解,并提出了中度、重度和终末期慢性肾脏疾病患者的HF药物滴定策略。
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来源期刊
Current Heart Failure Reports
Current Heart Failure Reports Medicine-Emergency Medicine
CiteScore
5.30
自引率
0.00%
发文量
44
期刊介绍: This journal intends to provide clear, insightful, balanced contributions by international experts that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of heart failure. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as investigative, pharmacologic, and nonpharmacologic therapies, pathophysiology, and prevention. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
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