ABSTRACT
INTRODUCTION: Chronic heart failure (HF) has high rates of mortality and hospitalization in patients with advanced chronic kidney disease (aCKD). However, randomized clinical trials have systematically excluded aCKD population. We have investigated current HF therapy in patients receiving clinical care in specialized aCKD units. METHODS: The Heart And Kidney Audit (HAKA) was a cross-sectional and retrospective real-world study including outpatients with aCKD and HF from 29 Spanish centers. The objective was to evaluate how the treatment of HF in patients with aCKD complied with the recommendations of the European Society of Cardiology Guidelines for the diagnosis and treatment of HF, especially regarding the foundational drugs: renin-angiotensin system inhibitors (RASi), angiotensin receptor blocker/neprilysin inhibitors (ARNI), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter-2 inhibitors (SGLT2i). RESULTS: Among 5,012 aCKD patients, 532 (13%) had a diagnosis of HF. Of them, 20% had reduced ejection fraction (HFrEF), 13% mildly reduced EF (HFmrEF), and 67% preserved EF (HFpEF). Only 9.3% of patients with HFrEF were receiving quadruple therapy with RASi/ARNI, BB, MRA, and SGLT2i, but the majority were not on the maximum recommended doses. None of the patients with HFrEF and CKD G5 received quadruple therapy. Among HFmrEF patients, approximately half and two-thirds were receiving RASi and/or BB, respectively, while less than 15% received ARNI, MRA, or SGLT2i. Less than 10% of patients with HFpEF were receiving SGLT2i. CONCLUSIONS: Under real-world conditions, HF in aCKD patients is sub-optimally treated. Increased awareness of current guidelines and pragmatic trials specifically enrolling these patients represent unmet medical needs.
Subject(s)
Adrenergic beta-Antagonists , Angiotensin Receptor Antagonists , Heart Failure , Mineralocorticoid Receptor Antagonists , Renal Insufficiency, Chronic , Sodium-Glucose Transporter 2 Inhibitors , Stroke Volume , Humans , Heart Failure/complications , Heart Failure/drug therapy , Heart Failure/physiopathology , Retrospective Studies , Male , Female , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/physiopathology , Aged , Cross-Sectional Studies , Mineralocorticoid Receptor Antagonists/therapeutic use , Angiotensin Receptor Antagonists/therapeutic use , Adrenergic beta-Antagonists/therapeutic use , Sodium-Glucose Transporter 2 Inhibitors/therapeutic use , Stroke Volume/physiology , Middle Aged , Spain/epidemiology , Guideline Adherence , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Aged, 80 and overABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Inappropriate Prescribing/statistics & numerical data , Potentially Inappropriate Medication List/statistics & numerical data , Dialysis , Renal Insufficiency/therapyABSTRACT
No disponible
Subject(s)
Humans , Medication Reconciliation , Medication Errors/prevention & control , Drug Prescriptions/standards , Patient Discharge/standardsABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Acute Kidney Injury/etiology , Complement System Proteins/deficiency , Nephritis, Interstitial/chemically induced , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Diagnosis, Differential , BiopsySubject(s)
Acute Kidney Injury/etiology , Glomerulonephritis, Membranoproliferative/complications , Nephritis, Interstitial/diagnosis , Aged , Diagnosis, Differential , Emergencies , Fluorescent Antibody Technique, Direct , Glomerulonephritis, Membranoproliferative/diagnosis , Humans , Lupus Nephritis/diagnosis , Male , Nephritis, Interstitial/blood , Nephritis, Interstitial/complications , Sjogren's Syndrome/diagnosisABSTRACT
No disponible
