Current Evidence on Treatment of Patients With Chronic Systolic Heart Failure and Renal Insufficiency
Current Evidence on Treatment of Patients With Chronic Systolic Heart Failure and Renal Insufficiency
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DOI：
10.1016/j.jacc.2013.11.031
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发表时间：
2014-03-11
影响因子：
24
通讯作者：
McMurray, John J. V.
中科院分区：
文献类型：
--
作者：
Damman, Kevin;Tang, W. H. Wilson;McMurray, John J. V.
慢性肾脏病（CKD）在慢性收缩性心力衰竭患者中越来越普遍。因此，循证治疗越来越多地用于一定程度的肾功能不全患者。然而，大多数关键性随机临床试验专门排除了（重度）肾功能不全患者。这些循证疗法在这一高危患者群体中的获益在很大程度上尚不清楚。本文回顾了收缩性心力衰竭的随机临床试验数据，以及基线肾功能不全和随机治疗效果之间的相互作用。它强调了大多数循证治疗在中度肾功能不全（3期CKD）患者中显示出一致的结局获益，而重度（4至5期CKD）肾功能不全患者的数据非常缺乏。如果有，与肾功能相对保留的患者相比，3期CKD的结局获益可能更大。然而，治疗处方应个体化，考虑可能的危害和益处，特别是在数据有限的4 - 5期CKD患者中。(C)2014年美国心脏病学会基金会
Chronic kidney disease (CKD) is increasingly prevalent in patients with chronic systolic heart failure. Therefore, evidence-based therapies are more and more being used in patients with some degree of renal dysfunction. However, most pivotal randomized clinical trials specifically excluded patients with (severe) renal dysfunction. The benefit of these evidence-based therapies in this high-risk patient group is largely unknown. This paper reviews data from randomized clinical trials in systolic heart failure and the interactions between baseline renal dysfunction and the effect of randomized treatment. It highlights that most evidence-based therapies show consistent outcome benefit in patients with moderate renal insufficiency (stage 3 CKD), whereas there are very scarce data on patients with severe (stage 4 to 5 CKD) renal insufficiency. If any, the outcome benefit might be even greater in stage 3 CKD compared with those with relatively preserved renal function. However, prescription of therapies should be individualized with consideration of possible harm and benefit, especially in those with stage 4 to 5 CKD where limited data are available. (C) 2014 by the American College of Cardiology Foundation