Key result
Management in an inter-disciplinary clinic improved guideline-directed medical therapy and significantly reduced iron deficiency from 56.7% at baseline to 26.8% at last visit (P=0.002).
Why the study?
CKD-HF patients are often undertreated with life-prolonging therapies due to fears of worsening renal function and hyperkalaemia, and the role of inter-disciplinary clinics in improving therapy is unknown.
Does management in an inter-disciplinary clinic improve guideline-directed medical therapy prescription and biochemical markers in patients with heart failure and CKD?
Observational (n=124)
Does management in an inter-disciplinary clinic improve guideline-directed medical therapy prescription and biochemical markers in patients with heart failure and CKD?
Absolute Event Rate: 26.8% vs 56.7%
p-value: p=0.002
Inter-disciplinary kidney-heart failure clinics can successfully optimize guideline-directed medical therapy and iron status in patients with concurrent HF and CKD without worsening renal function or hyperkalemia.
Interdisciplinary care may boost RAASi/MRA adherence in CKD-HF without worsening potassium or creatinine; leaves open effects on mortality or hospitalization.
AIMS: CKD-HF patients suffer excess hospitalization and mortality, often under-treated with life-prolonging medications due to fear of worsening renal function and hyperkalaemia. Yet, role of inter-disciplinary working in improving therapy is unknown, which this study aims to investigate. METHODS AND RESULTS: Clinical, biochemical data, and medications at first and last clinic visit were obtained from patient records for 124 patients seen in kidney failure-heart failure clinic (23 March 2017 to 11 April 2019). Medication dose groups (none, low, and high dose), number of RAASi agents, and blood test results were compared between first and last visit in patients with at least two clinic visits (n = 97). Patient characteristics were age 78.5 years (IQR 68.1-84.4 years), male 67.7%, diabetes 51.6%, moderate (45.2%) vs. severe (39.5%) CKD, HF with reduced ejection fraction (HFrEF) (49.2%), follow-up 234 days (IQR 121-441 days). HFrEF was associated with increased risk of death (adjusted OR 4.49, 95% CI 1.43-14.05; P = 0.01). Distributions of patients according to number of RAASi agents they were on differed between first and last visit (P = 0.03). Dosage was increased in 25.9% for beta-blockers, 33.0% for ACEi/ARBs, and 17.5% for MRAs. Distributions of patients across MRA dosage groups was different (P = 0.03), with higher proportions on higher dosages at last visit, without significant changes in serum potassium or creatinine. Serum ferritin improved (131.0 vs. 267.5 μg/L; P < 0.001), and fewer patients had iron deficiency (56.7% vs. 26.8%; P = 0.002) at last visit compared to the first. CONCLUSIONS: This inter-disciplinary clinic improved guideline-recommended medication prescription, MRA dosages in CKD-HF patients without significant biochemical abnormality, and iron status. A prospectively designed study with medication titration protocol and defined patient-centred outcomes is needed to further assess effectiveness of such clinic.
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Nguyen et al. (2020) conducted an observational in Heart Failure with Chronic Kidney Disease (CKD-HF) (n=124). Inter-disciplinary kidney failure-heart failure clinic management vs. Baseline (first clinic visit) was evaluated on Iron deficiency (p=0.002). Management in an inter-disciplinary clinic improved guideline-directed medical therapy and significantly reduced iron deficiency from 56.7% at baseline to 26.8% at last visit (P=0.002).
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