Key result
Inclusion of patients with advanced CKD grades 4-5 in HFrEF trials occurred in 57% of 706 articles, and over 10 years this proportion increased while ACEI/ARB use concurrently decreased.
Why the study?
ACEI, ARB, ARNI, and MRA reduce mortality and hospitalizations in HFrEF, but their use is limited in advanced CKD.
Has the inclusion of advanced CKD patients in HFrEF trials and the reported use of RAAS inhibitors changed over time?
Systematic Review (n=706)
Has the inclusion of advanced CKD patients in HFrEF trials and the reported use of RAAS inhibitors changed over time?
Despite increasing inclusion of patients with advanced CKD in HFrEF trials over the past decade, the reported use of ACEI/ARB therapy in these trials has paradoxically decreased.
Despite rising advanced CKD inclusion in HFrEF trials, ACEI/ARB use declined; challenges RAASi representation assumptions and extends need for targeted trials.
Introduction: Angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), angiotensin receptor-neprilysin inhibitor (ARNI), and mineralocorticoid receptor antagonists (MRA) reduce mortality and hospitalizations in heart failure with reduced ejection fraction (HFrEF) but their use is limited in advanced chronic kidney disease (CKD). Methods: We carried out a systematic review of studies on HFrEF and CKD patients. The mean overall percentage of reported ACEI, ARB, MRA, and ARNI use, and the proportion of trials that included patients with advanced CKD grades 4-5 (estimated glomerular filtration rate (eGFR) <15-30 ml/min/1.73m2) were recorded per year. The proportion of trials with advanced CKD was logtransformed, and then fitted into a time regression model. The interactions between the proportion of trials that included CKD grades 4-5 and the proportion of reported use of ACEI, ARB, and MRAs per year were explored using Pearson’s correlation and univariate linear regression. Results: A total of 706 articles were included; 76% reported background ACEI/ARB use, while 51% reported MRA use. ACEI/ARB use averaged 83% and MRA 50%. Of the trials, 57% included CKD grades 4-5. Over 10 years, the proportion of trials with CKD grades 4-5 increased while ACEI/ARB use decreased. MRA use rates remained about the same. There was an inverse association found between the proportion of trials with CKD grades 4-5 and ACEI/ARB use per year. Conclusion: In the past 10 years, CKD grades 4-5 patients have been increasingly included in HFrEF clinical trials. Concurrently, ACEI/ARB use has reportedly decreased.
No takes yet. Share an insight, caveat, or question.
Al‐Sudani et al. (2023) conducted a systematic review in Heart failure with reduced ejection fraction and advanced chronic kidney disease (n=706). Renin Angiotensin Aldosterone System Inhibitor Use was evaluated on Proportion of trials including advanced CKD grades 4-5 and reported use of ACEI, ARB, and MRAs per year. Inclusion of patients with advanced CKD grades 4-5 in HFrEF trials occurred in 57% of 706 articles, and over 10 years this proportion increased while ACEI/ARB use concurrently decreased.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: