Why the study?
Patients with advanced CKD and heart failure are excluded from most cardiovascular clinical trials, resulting in little direct evidence and under-prescription of heart failure therapies.
Highlights the critical lack of direct evidence for heart failure therapies in patients with advanced chronic kidney disease due to their systematic exclusion from clinical trials.
Reveals major evidence gap for HF therapies in advanced CKD; supports dedicated inclusive RCTs to guide care.
Despite the high prevalence of chronic kidney disease (CKD) and its high cardiovascular risk, patients with CKD, especially those with advanced CKD (stages 4-5 and patients on kidney replacement therapy), are excluded from most cardiovascular clinical trials. It is particularly relevant in patients with advanced CKD and heart failure (HF) who have been underrepresented in many pivotal randomized trials that have modified the management of HF. For this reason, there is little or no direct evidence for HF therapies in patients with advanced CKD and treatment is extrapolated from patients without CKD or patients with earlier CKD stages. The major consequence of the lack of direct evidence is the under-prescription of HF drugs to this patient population. As patients with advanced CKD and HF represent probably the highest cardiovascular risk population, the exclusion of these patients from HF trials is a serious deontological fault that must be solved. There is an urgent need to generate evidence on how to treat HF in patients with advanced CKD. This article briefly reviews the management challenges posed by HF in patients with CKD and proposes a road map to address them.
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Ortíz et al. (2021) studied this question.
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