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February 28, 2022CirculationOpen Access

Evidence-Based Medical Therapy in Patients With Heart Failure With Reduced Ejection Fraction and Chronic Kidney Disease

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Why the study?

Pivotal HFrEF randomized clinical trials have historically excluded patients with stage 4 and 5 CKD, leaving limited information on the efficacy and tolerability of HFrEF therapies in these patients.

Are evidence-based medical therapies for HFrEF safe and effective in patients with concurrent chronic kidney disease?

Design

Review

Discussion

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Overview

Supports continuing HFrEF therapies in CKD stage 3B despite initial eGFR decline; leaves open dedicated trials for stage 4-5.

Structured PICO

Are evidence-based medical therapies for HFrEF safe and effective in patients with concurrent chronic kidney disease?

P
Population
Patients with heart failure with reduced ejection fraction (HFrEF) and chronic kidney disease (CKD)
I
Intervention
Evidence-based medical therapies for HFrEF (including ACE inhibitors, ARBs, MRAs, ARNIs, SGLT2 inhibitors, vericiguat, digoxin, and omecamtiv mecarbil)
O
Outcome
All-cause mortality and the combined end point of cardiovascular death or heart failure hospitalizationcomposite

This review highlights that evidence-based HFrEF therapies remain safe and effective in moderate-to-severe CKD, and initial eGFR dips are expected and should not lead to therapy discontinuation.

Cite This Study

A 2022 study studied this question.

synapsesocial.com/papers/6a7e525cfff18652e232f6c2https://doi.org/10.1161/circulationaha.121.052792
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Managing Heart Failure With Reduced Ejection Fraction in Patients With Chronic Kidney Disease: A Case-Based Approach and Contemporary Review2022 · 4 citations
  2. 2Management of Heart Failure Patient with CKD2021 · 105 citations
  3. 3Personalizing heart failure management in chronic kidney disease patients2021 · 18 citations
  4. 4Renal protection in heart failure with reduced ejection fraction: not all that glitters is gold2025 · 3 citations
  5. 5The Treatment of Heart Failure in Patients with Chronic Kidney Disease: Doubts and New Developments from the Last ESC Guidelines2022 · 21 citations