Treatment of Chronic Heart Failure in Advanced Chronic Kidney Disease: The HAKA Multicenter Retrospective Real-World Study.

Fecha de publicación: Fecha Ahead of Print:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Quiroga B
  • Ortiz A
  • Núñez S
  • Kislikova M
  • González Sanchidrián S
  • Broseta JJ
  • Albines ZS
  • Escamilla Cabrera B
  • Rivero Viera Y
  • Rodriguez Santarelli D
  • Salanova Villanueva L
  • Lopez Rodriguez F
  • Cancho Castellano B
  • Ibáñez Cerezon M
  • Gutierrez Rivas CP
  • Aresté N
  • Campos Gutiérrez B
  • Ródenas Gálvez A
  • Glucksmann Pizá MC
  • Balda Manzanos S
  • Rodríguez Gayo L
  • Moral Berrio E
  • Ortega Diaz M
  • Beltrán Catalán S
  • Puente García A
  • Ángel Rojas M
  • Sosa Barrios RH
  • Santana Zapatero H
  • Rangel Hidalgo G
  • Martinez Canet AM
  • Díez J
  • Cardiorenal Medicine Group (CaReSEN) of the Spanish Society of Nephrology

Abstract

INTRODUCTION: Chronic heart failure (HF) has high rates of mortality and hospitalization in patients with advanced chronic kidney disease (aCKD). However, randomized clinical trials have systematically excluded aCKD population. We have investigated current HF therapy in patients receiving clinical care in specialized aCKD units. METHODS: The Heart And Kidney Audit (HAKA) was a cross-sectional and retrospective real-world study including outpatients with aCKD and HF from 29 Spanish centers. The objective was to evaluate how the treatment of HF in patients with aCKD complied with the recommendations of the European Society of Cardiology Guidelines for the diagnosis and treatment of HF, especially regarding the foundational drugs: renin-angiotensin system inhibitors (RASi), angiotensin receptor blocker/neprilysin inhibitors (ARNI), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter-2 inhibitors (SGLT2i). RESULTS: Among 5,012 aCKD patients, 532 (13%) had a diagnosis of HF. Of them, 20% had reduced ejection fraction (HFrEF), 13% mildly reduced EF (HFmrEF), and 67% preserved EF (HFpEF). Only 9.3% of patients with HFrEF were receiving quadruple therapy with RASi/ARNI, BB, MRA, and SGLT2i, but the majority were not on the maximum recommended doses. None of the patients with HFrEF and CKD G5 received quadruple therapy. Among HFmrEF patients, approximately half and two-thirds were receiving RASi and/or BB, respectively, while less than 15% received ARNI, MRA, or SGLT2i. Less than 10% of patients with HFpEF were receiving SGLT2i. CONCLUSIONS: Under real-world conditions, HF in aCKD patients is sub-optimally treated. Increased awareness of current guidelines and pragmatic trials specifically enrolling these patients represent unmet medical needs.

© 2024 The Author(s). Published by S. Karger AG, Basel.

Datos de la publicación

ISSN/ISSNe:
1664-3828, 1664-5502

CardioRenal Medicine  S. Karger AG

Tipo:
Article
Páginas:
202-214
Factor de Impacto:
0,600 SCImago
Cuartil:
Q2 SCImago

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Keywords

  • Advanced chronic kidney disease; Cardiorenal syndrome; Chronic heart failure; Heart failure therapy

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