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Janse RJ, Fu EL, Dahlström U, Benson L, Lindholm B, van Diepen M, Dekker FW, Lund LH, Carrero JJ, Savarese G. Use of guideline-recommended medical therapy in patients with heart failure and chronic kidney disease: from physician's prescriptions to patient's dispensations, medication adherence and persistence. Eur J Heart Fail 2022; 24:2185-2195. [PMID: 35851740 PMCID: PMC10087537 DOI: 10.1002/ejhf.2620] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/25/2022] [Accepted: 07/13/2022] [Indexed: 01/18/2023] Open
Abstract
AIM Half of heart failure (HF) patients have chronic kidney disease (CKD) complicating their pharmacological management. We evaluated physicians' and patients' patterns of use of evidence-based medical therapies in HF across CKD stages. METHODS AND RESULTS We studied HF patients with reduced (HFrEF) and mildly reduced (HFmrEF) ejection fraction enrolled in the Swedish Heart Failure Registry in 2009-2018. We investigated the likelihood of physicians to prescribe guideline-recommended therapies to patients with CKD, and of patients to fill the prescriptions within 90 days of incident HF (initiating therapy), to adhere (proportion of days covered ≥80%) and persist (continued use) on these treatments during the first year of therapy. We identified 31 668 patients with HFrEF (median age 74 years, 46% CKD). The proportions receiving a prescription for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors (ACEi/ARB/ARNi) were 96%, 92%, 86%, and 68%, for estimated glomerular filtration rate (eGFR) ≥60, 45-59, 30-44, and <30 ml/min/1.73 m2 , respectively; for beta-blockers 94%, 93%, 92%, and 92%, for mineralocorticoid receptor antagonists (MRAs) 45%, 44%, 37%, 24%; and for triple therapy (combination of ACEi/ARB/ARNi + beta-blockers + MRA) 38%, 35%, 28%, and 15%. Patients with CKD were less likely to initiate these medications, and less likely to adhere to and persist on ACEi/ARB/ARNi, MRA, and triple therapy. Among stoppers, CKD patients were less likely to restart these medications. Results were consistent after multivariable adjustment and in patients with HFmrEF (n = 15 114). CONCLUSIONS Patients with HF and CKD are less likely to be prescribed and to fill prescriptions for evidence-based therapies, showing lower adherence and persistence, even at eGFR categories where these therapies are recommended and have shown efficacy in clinical trials.
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Affiliation(s)
- Roemer J Janse
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Edouard L Fu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ulf Dahlström
- Department of Cardiology and the Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Lina Benson
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Lindholm
- Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Division of Nephrology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
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Cheng S, Zhou T, Yu L, Chen Y, Zhang Z, Wang J, Yu Y. The Effect of Sacubitril/Valsartan Treatment on Cardiac and Renal Functions of a Patient With Cardiorenal Syndrome Type 4 and Stage 5 CKD After More Than Three Years of Follow-Up. Front Med (Lausanne) 2022; 9:817833. [PMID: 35360715 PMCID: PMC8962615 DOI: 10.3389/fmed.2022.817833] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
It is difficult to treat cardiorenal syndrome (CRS) in clinical practice, which is the common reason for the death of patients. This report aimed to describe the effects of sacubitril/valsartan treatment on cardiac and renal functions of a patient with cardiorenal syndrome type 4 (CRS4) after more than 3 years of follow-up. A 77-year-old Chinese woman was admitted to our hospital because of CRS4 and stage 5 chronic kidney disease (CKD), who had a history of long-term proteinuria and renal failure. The patient's cardiothoracic ratio (CTR) measured by chest X–ray was 0.6. Cardiac ultrasonography showed that the left ventricular ejection fraction (LVEF) was 0.40. The patient had been treated for heart failure (HF) for 5 months, but there was no improvement in clinical manifestations, and the renal function gradually deteriorated. In our hospital, she received sacubitril/valsartan treatment for at least 40 months. The symptoms of HF relieved, and the indices of cardiac function improved. In addition, the patient's renal function was stable. During the treatment, the dosage of sacubitril/valsartan needed to be adjusted to achieve the optimal therapeutic effect. Follow-up results showed that she achieved cardiac function of New York Heart Association (NYHA) class II with an ejection fraction of 0.60 and E/A > 1 indicated by echocardiogram, and did not develop hyperkalemia. In summary, the improvement of cardiac and renal functions of the CRS4 patient was associated with the long-term sacubitril/valsartan treatment.
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Li BH, Fang KF, Lin PH, Zhang YH, Huang YX, Jie H. Effect of sacubitril valsartan on cardiac function and endothelial function in patients with chronic heart failure with reduced ejection fraction. Clin Hemorheol Microcirc 2021; 77:425-433. [PMID: 33386797 DOI: 10.3233/ch-201032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of the present study was to observe the effect of sacubitril valsartan on cardiac function and vascular endothelial function in patients with chronic heart failure with reduced ejection fraction (HFrEF). METHODS A total of 80 patients with HFrEF were randomly divided into an observation group and a control group, with 40 patients in each group. Sacubitril valsartan was added to the conventional treatment in the observation group, and perindopril was added to the conventional treatment in the control group. Both groups were treated continuously for 12 weeks. The left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), flow-mediated vasodilatory function (FMD) of the brachial artery, and levels of plasma Ang II, endothelin 1 (ET-1), and calcitonin gene-related peptide (CGRP), together with the serum nitric oxide (NO) and NO synthase (NOS) were compared before and after treatment in the groups. RESULTS Before the treatment, the levels of LVEF, LVEDD, FMD, Ang II, ET-1, CGRP, NO, and NOS in the observation group were not significantly different from those in the control group (P > 0.05). However, the levels of LVEF, FMD, CGRP, NO, and NOS in both groups were significantly higher after the treatment than those before the treatment (P < 0.05) and significantly higher in the observation group than those in the control group. The difference was statistically significant (P < 0.05). Meanwhile, the levels of LVEDD, Ang II, and ET-1 in both groups decreased significantly after the treatment (P < 0.05) and were significantly lower in the observation group than those in the control group. The difference was statistically significant (P < 0.05). CONCLUSION Sacubitril valsartan might improve endothelial function while increasing cardiac function in HFrEF patients.
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Affiliation(s)
- Bao-Hua Li
- Department of Cardiology, Affiliated Huiyang Hospital of Southern Medical University, Huizhou, China
| | - Kuai-Fa Fang
- Department of Cardiology, Affiliated Huiyang Hospital of Southern Medical University, Huizhou, China
| | - Pei-Huan Lin
- Department of Cardiology, Affiliated Huiyang Hospital of Southern Medical University, Huizhou, China
| | - Yi-Hui Zhang
- Department of Cardiology, Affiliated Huiyang Hospital of Southern Medical University, Huizhou, China
| | - Yong-Xiang Huang
- Department of Cardiology, Affiliated Huiyang Hospital of Southern Medical University, Huizhou, China
| | - Hai Jie
- Department of Cardiology, Affiliated Huiyang Hospital of Southern Medical University, Huizhou, China
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4
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Rossignol P, Duarte K, Girerd N, Karoui M, McMurray JJ, Swedberg K, Veldhuisen DJ, Pocock S, Dickstein K, Zannad F, Pitt B. Cardiovascular risk associated with serum potassium in the context of mineralocorticoid receptor antagonist use in patients with heart failure and left ventricular dysfunction. Eur J Heart Fail 2020; 22:1402-1411. [DOI: 10.1002/ejhf.1724] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/04/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Patrick Rossignol
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques‐ Plurithématique 14‐33, and Inserm U1116, CHRU de Nancy, F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists) Nancy France
| | - Kevin Duarte
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques‐ Plurithématique 14‐33, and Inserm U1116, CHRU de Nancy, F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists) Nancy France
| | - Nicolas Girerd
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques‐ Plurithématique 14‐33, and Inserm U1116, CHRU de Nancy, F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists) Nancy France
| | - Moez Karoui
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques‐ Plurithématique 14‐33, and Inserm U1116, CHRU de Nancy, F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists) Nancy France
| | - John J.V. McMurray
- The British Heart Foundation Cardiovascular Research Centre University of Glasgow Glasgow UK
| | - Karl Swedberg
- Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Dirk J. Veldhuisen
- University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - Stuart Pocock
- Department of Biostatistics London School of Hygiene & Tropical Medicine London UK
| | - Kenneth Dickstein
- Department of Cardiology University of Bergen, Stavanger University Hospital Stavanger Norway
| | - Faiez Zannad
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques‐ Plurithématique 14‐33, and Inserm U1116, CHRU de Nancy, F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists) Nancy France
| | - Bertram Pitt
- University of Michigan School of Medicine Ann Arbor MI USA
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Abstract
Cardiorenal syndromes have been categorized into 5 clinical subtypes based on which organ is perceived to be the primary precipitant of the vicious and interrelated cycle of declining function in both organs. This clinical classification has broadened interest in cardiorenal interactions, but it is merely descriptive, does not rely on or inform predominant pathophysiology, and has produced little change in either practice or the research agenda. In contrast, recent scientific work identifies common pathophysiological pathways for several categories of cardiorenal syndromes, suggesting a unifying pathogenesis. Fibrosis is a common consequence of inflammation- and oxidative stress-related endothelial dysfunction in aging, hypertension, diabetes mellitus, obesity, ischemia, and organ injury. It is a common feature in heart failure and chronic kidney disease. Therefore, we suggest that fibrosis may be not only a marker but also the primary driver of pathophysiology in several cardiorenal syndromes. Interstitial fibrosis in the heart, large arteries, and kidneys may play a key role in the pathophysiology of the cardiorenal syndrome continuum. Focusing on fibrosis as a disease mediator might enable the identification of fibrosis-related biotargets that could potentially be modulated with renin-angiotensin-aldosterone system inhibitors, mineralocorticoid receptor antagonists, or other novel antifibrotic agents in development. This conceptual approach may be an effective new strategy for the prevention and treatment of fibrosis within the cardiorenal syndrome continuum.
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Affiliation(s)
- Faiez Zannad
- Universite de Lorraine, Inserm, Centre d'Investigations Cliniques-1433 and Inserm U1116, CHRU Nancy, France (F.Z., P.R.).,F-CRIN INI-CRCT, Nancy, France (F.Z., P.R.)
| | - Patrick Rossignol
- Universite de Lorraine, Inserm, Centre d'Investigations Cliniques-1433 and Inserm U1116, CHRU Nancy, France (F.Z., P.R.).,F-CRIN INI-CRCT, Nancy, France (F.Z., P.R.).,Association Lorraine pour le Traitement de l'Insuffisance Rénale, Nancy, France (P.R.)
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Rossignol P. A new area for the management of hyperkalaemia with potassium binders: clinical use in nephrology. Eur Heart J Suppl 2019; 21:A48-A54. [PMID: 30837805 PMCID: PMC6392417 DOI: 10.1093/eurheartj/suy032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Chronic kidney disease (CKD) patients and more so CKD patients treated with renin-angiotensin-aldosterone system inhibitors (RAASi) are prone to experience hyperkalaemia, a condition associated with an increased risk of death. This represents a true dilemma in daily practice since RAASi are the cornerstones of nephroprotective and cardioprotective strategies in CKD patients, as well as in hypertensive patients with or without CKD. The recent availability in the USA and EU of the potassium-binding resin Patiromer, together with sodium zirconium cyclosilicate (SZC), which was more recently approved in the EU and the US, may lead to a paradigm shift both in the treatment of hyperkalaemia and in enabling RAASi maintenance. Whether potassium normalization, potentially combined with a RAASi maintenance strategy, may translate into improved cardiovascular and renal outcomes needs be tested prospectively.
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Affiliation(s)
- Patrick Rossignol
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques- Plurithématique 1433, Inserm U1116, CHRU Nancy, and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Association Lorraine de Traitement de l'Insuffisance Rénale, Nancy, France
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7
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Pitt B, Rossignol P. Relation of Serum Potassium to Cardiovascular Events in Patients With Heart Failure and Preserved Ejection Fraction: "Mind the Gap". Am J Hypertens 2018; 31:1087-1089. [PMID: 30060111 DOI: 10.1093/ajh/hpy107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 07/26/2018] [Indexed: 01/21/2023] Open
Affiliation(s)
- Bertram Pitt
- University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Patrick Rossignol
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique, Inserm U1116, CHRU Nancy, and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
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8
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K Dojki F, Bakris GL. Hyperkalaemia in diabetes: a silent risk predicting poor outcomes. Diabet Med 2018; 35:1049-1050. [PMID: 29790205 DOI: 10.1111/dme.13683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2018] [Indexed: 11/27/2022]
Affiliation(s)
- F K Dojki
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Illinois at Chicago, Chicago, IL, USA
| | - G L Bakris
- Department of Medicine, Comprehensive Hypertension Center, Section of Endocrinology, University of Chicago Medicine, Chicago, IL, USA
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9
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Pitt B, Rossignol P. Mineralocorticoid Receptor Antagonists in High-Risk Heart Failure Patients With Diabetes Mellitus and/or Chronic Kidney Disease. J Am Heart Assoc 2017; 6:JAHA.117.008054. [PMID: 29275377 PMCID: PMC5779066 DOI: 10.1161/jaha.117.008054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Bertram Pitt
- University of Michigan School of Medicine, Ann Arbor, MI
| | - Patrick Rossignol
- Inserm, Centre d'Investigations Cliniques-Plurithématique 14-33, Inserm U1116, CHRU Nancy Université de Lorraine, Nancy, France.,F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
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10
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Pitt B, Rossignol P. Serum potassium in patients with chronic heart failure: once we make a U-turn where should we go? Eur Heart J 2017; 38:2897-2899. [DOI: 10.1093/eurheartj/ehx537] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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11
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Vincent J. Drugs and the Kidneys: Clinical Pharmacology Perspectives. Clin Pharmacol Ther 2017; 102:368-372. [PMID: 28782823 DOI: 10.1002/cpt.775] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 06/19/2017] [Indexed: 12/14/2022]
Abstract
The focus of this edition of Clinical Pharmacolgoy & Therapeutics (CPT) is on drugs and renal function and will not include a detailed discussion of kidney disease and its treatment. It is well recognized that drugs affect the kidneys in different ways, while kidney disease impacts drug metabolism and response. It is impossible to underestimate the value of the kidneys to man in health and disease, from regulation of fluid and electrolyte balance to participating in drug metabolism and transport. Additionally, the kidneys serve as targets for drugs used to treat cardiovascular (CV) diseases including hypertension and heart failure, metabolic diseases such as diabetes mellitus and obesity, chronic kidney disease (CKD), as well as playing a role in the regulation of several hormones. Kidney damage may be distinguished from changes in kidney function using biomarkers, as discussed in some detail in this issue.
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