Abstract

MANAGEMENT PATTERNS AND ASSOCIATED OUTCOMES IN HEART FAILURE PATIENTS WITH RENAL IMPAIRMENT

Asif Rasheed*, Khuba Raniya, Maryam Sadiq, Mohd Abdul Mughani and Mohammed Akram Rayan Ahmed

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Abstract

Chronic kidney disease (CKD) is an increasing prevalence in heart failure (HF) patients, and HF is the leading cause of hospitalization, morbidity, and mortality in patients with renal impairment. Current symptoms and prognosis of beta-blockers, renin-angiotensinaldosterone inhibitors (RAASis), angiotensin receptor-neprilysin inhibitors (ARNI), and mineralocorticoid receptor antagonists (MRA) in patients with heart failure and CKD stages There is strong evidence to support its benefits. Support.[1-3] However, ARNI, RAASis, and MRA are often suboptimally prescribed in CKD patients due to concerns about hyperkalemia and worsening renal function. There is increasing evidence for the use of sodium-glucose cotransporter-2 inhibitors and IV iron therapy in the management of heart failure in patients with chronic renal failure. However, there are only a few studies in patients with CKD stages[4–5] and dialysis patients, limiting the assessment of the safety and efficacy of these treatments in his advanced CKD. Interdisciplinary contributions from heart failure and renal professionals are needed to ensure integrated care for the growing number of patients with heart failure and chronic kidney disease. The heart and kidneys are closely linked in the clinical syndrome of heart failure (HF). It is now fully understood that renal dysfunction is common to all heart failure phenotypes and, when present, is associated with increased mortality and morbidity. Much is known about cardiorenal interactions in heart failure, but unresolved questions remain. The next decade should provide more specialized epidemiological, mechanistic, and controlled studies in heart failure patients with renal impairment. An updated classification of cardiorenal syndromes, incorporating new evidence, and identifying areas of concern and uncertainty, as well as areas in need of progress, may facilitate this process. Ultimately, this should lead to preventive and therapeutic strategies that can preserve renal function and associated outcomes in heart failure patients.

Keywords: renin-angiotensin-aldosterone inhibitors (RAASis), angiotensin receptor-neprilysin inhibitors (ARNI), iron therapy, ivabradine.