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Shi Y, Wang Y, Chen J, Lu C, Xuan H, Wang C, Li D, Xu T. Effects of angiotensin receptor neprilysin inhibitor on renal function in patients with heart failure: a systematic review and meta-analysis. Postgrad Med J 2021; 99:postgradmedj-2021-140132. [PMID: 34083361 DOI: 10.1136/postgradmedj-2021-140132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/19/2021] [Indexed: 12/27/2022]
Abstract
The angiotensin receptor neprilysin inhibitor (ARNI) has been recommended as a first-line treatment in patients with heart failure (HF). However, the effects of ARNI on renal function remain controversial.The PubMed, Embase, the Cochrane Library of Trials and Web of Science were searched in the period from inception to 31 January 2021. Randomised controlled trial, cohort studies and observational studies reporting at least one of renal function indicators were included.In patients with HF with reduced ejection fraction (HFrEF), ARNI did not lead to a significant decrease in estimated glomerular filtration rate (eGFR, p=0.87), and the risk of worsening renal function (WRF) dropped by 11% compared with control group. Though the level of serum creatinine (SCr) and serum potassium had a slight increase (p=0.01; p=0.02), in contrast to the baseline level, but without clinical significance. In patients with HF with preserved ejection fraction (HFpEF), the level of SCr and serum potassium did not have a significant change, and patients with HFpEF assigned to ARNI had a much lower rate of WRF (p=0.0007). In contrast to control group, both patients with HFrEF and HFpEF had a less decrease in eGFR and a lower rate of hyperkalaemia in ARNI group.ARNI did not lead to a significant decrease in eGFR in HFrEF. Compared with control group, ARNI could delay the progression of decrease in eGFR and result in less events of hyperkalaemia in patients with HF. Besides, patients with HFpEF had a lower rate in the events of WRF.
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Affiliation(s)
- Yuwu Shi
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yiwen Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Junhong Chen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chi Lu
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Haochen Xuan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chaofan Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Dongye Li
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Tongda Xu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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Shchekochikhin D, Nikiforova T, Shilova A, Nesterov A, Baturina O, Gognieva D, Kozlovskaya N, Syrkin A, Kopylov P. Evaluation of discriminative capacity of two formulas of CKD-EPI to predict complications after the first episode of heart failure with preserved ejection fraction. Int J Nephrol Renovasc Dis 2019; 12:113-118. [PMID: 31190950 PMCID: PMC6511616 DOI: 10.2147/ijnrd.s196976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 04/12/2019] [Indexed: 12/28/2022] Open
Abstract
Background: Determining the prognosis of heart failure with preserved ejection fraction (HFpEF) is problematic, as the ejection fraction cannot be used. Formulae that estimate glomerular filtration rate (eGFR) may be potential prognosticators for this condition, since renal dysfunction is a well-known predictor of poor outcomes of all forms of heart failure. Methods: A prospective observational study of 117 HFpEF patients (average age 71.6±9.1 years; 65.8% women) who had eGFR determined after their first episode of cardiac decompensation by two different chronic kidney disease epidemiology collaboration (CKD-EPI) equations. The ability to predict hospitalizations and mortality over 24 months by the two equations were compared. Results: The CKD-EPI formula based on serum creatinine only performed poorly. However, the CKD-EPI equation that used both serum creatinine and serum cystatin C was associated with unfavorable outcome: eGFR <45 mL/min/1.73 m2 predicted 24-month mortality (HR=4.21 [1.32;13.43], p=0.02) and the combined endpoint of mortality and hospitalization (HR 2.45 [1.42;4.22], p=0.001). . Conclusions: eGFR by the CKD-EPI equation based on serum creatinine and cystatin C levels, but not by the CKD-EPI creatinine only equation, predicts the outcome of HFpEF patients.
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Affiliation(s)
- Dmitry Shchekochikhin
- Department of Preventive and Emergency Cardiology of the Faculty of Medicine, I.M. Sechenov First Moscow State Medical University, Moscow 119991, Russia
| | - Tatiana Nikiforova
- Department of Preventive and Emergency Cardiology of the Faculty of Medicine, I.M. Sechenov First Moscow State Medical University, Moscow 119991, Russia
| | - Alexandra Shilova
- Department of Interventional Cardiology and Cardiac Rehabilitation, Pirogov Russian National Research Medical University (RNRMU), Moscow 117997, Russia
| | - Alexey Nesterov
- Department of Interventional Cardiology and Cardiac Rehabilitation, Pirogov Russian National Research Medical University (RNRMU), Moscow 117997, Russia
| | - Olga Baturina
- Department of Preventive and Emergency Cardiology of the Faculty of Medicine, I.M. Sechenov First Moscow State Medical University, Moscow 119991, Russia
| | - Daria Gognieva
- Department of Preventive and Emergency Cardiology of the Faculty of Medicine, I.M. Sechenov First Moscow State Medical University, Moscow 119991, Russia
| | - Natalia Kozlovskaya
- Department of Internal Medicine and Occupational Medicine, Eramishancev Moscow Clinical Hospital, Moscow 129327, Russia
| | - Abram Syrkin
- Department of Preventive and Emergency Cardiology of the Faculty of Medicine, I.M. Sechenov First Moscow State Medical University, Moscow 119991, Russia
| | - Philipp Kopylov
- Department of Preventive and Emergency Cardiology of the Faculty of Medicine, I.M. Sechenov First Moscow State Medical University, Moscow 119991, Russia
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Rao VS, Ahmad T, Brisco-Bacik MA, Bonventre JV, Wilson FP, Siew ED, Felker GM, Anstrom KK, Mahoney DD, Bart BA, Tang WHW, Velazquez EJ, Testani JM. Renal Effects of Intensive Volume Removal in Heart Failure Patients With Preexisting Worsening Renal Function. Circ Heart Fail 2019; 12:e005552. [PMID: 31163974 DOI: 10.1161/circheartfailure.118.005552] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background The relationship between intensive volume removal in acute decompensated heart failure patients with preexisting worsening renal function (WRF) and renal tubular injury, postdischarge renal function, and clinical outcomes is unknown. Methods and Results We used data from the multicenter CARRESS-HF trial (Cardiorenal Rescue Study in Acute Decompensated Heart Failure) that randomized patients with acute decompensated heart failure and preexisting WRF to intensive volume removal with stepped pharmacological therapy or fixed rate ultrafiltration. Patients in the urinary renal tubular injury biomarker substudy (NAG [N-acetyl-b-D-glucosaminidase], KIM-1 [kidney injury molecule-1], and NGAL [neutrophil gelatinase-associated lipocalin]) were evaluated (N=105). The severity of prerandomization WRF was unrelated to baseline renal tubular injury biomarkers ( r=0.14; P=0.17). During randomized intensive volume removal, creatinine further worsened in 53% of patients. Despite a small to moderate magnitude increase in creatinine in most of these patients, postrandomization WRF was strongly associated with worsening in renal tubular injury biomarkers (odds ratio, 12.6; P=0.004). This observation did not differ by mode of volume removal (stepped pharmacological therapy versus ultrafiltration, Pinteraction=0.46). Increase in renal tubular injury biomarkers was associated with a higher incidence of hemoconcentration (odds ratio, 3.1; P=0.015), and paradoxically, better recovery of creatinine at 60 days ( P=0.01). Conclusions In acute decompensated heart failure patients with preexisting WRF, intensive volume removal resulted in a further worsening of creatinine approximately half of the time, a finding associated with a rise in tubular injury biomarkers. However, decongestion and renal function recovery at 60 days were superior in patients with increased tubular injury markers. These data suggest that the benefits of decongestion may outweigh any modest or transient increases in serum creatinine or tubular injury markers that occur during intensive volume removal. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT00608491.
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Affiliation(s)
- Veena S Rao
- Sections of Cardiovascular Medicine (V.S.R., T.A., D.D.M., E.J.V., J.M.T.), Yale University School of Medicine, New Haven, CT
| | - Tariq Ahmad
- Sections of Cardiovascular Medicine (V.S.R., T.A., D.D.M., E.J.V., J.M.T.), Yale University School of Medicine, New Haven, CT
| | - Meredith A Brisco-Bacik
- Cardiology Division, Lewis Katz School of Medicine at Temple University, Philadelphia, PA (M.A.B.-B.)
| | - Joseph V Bonventre
- Division of Renal Medicine, Brigham and Women's Hospital, Boston. MA (J.V.B.)
| | - F Perry Wilson
- Nephrology (F.P.W.), Yale University School of Medicine, New Haven, CT
| | - Edward D Siew
- Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease (VCKD) and Integrated Program for AKI (VIP-AKI), Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (E.D.S.)
| | - G Michael Felker
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (G.M.F., K.K.A.)
| | - Kevin K Anstrom
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (G.M.F., K.K.A.)
| | - Devin D Mahoney
- Sections of Cardiovascular Medicine (V.S.R., T.A., D.D.M., E.J.V., J.M.T.), Yale University School of Medicine, New Haven, CT
| | - Bradley A Bart
- Division of Cardiology, Hennepin County Medical Center, Minneapolis, MN (B.A.B.)
| | - W H Wilson Tang
- Section of Heart Failure and Cardiac Transplantation, Cleveland Clinic, OH (W.H.W.T.)
| | - Eric J Velazquez
- Sections of Cardiovascular Medicine (V.S.R., T.A., D.D.M., E.J.V., J.M.T.), Yale University School of Medicine, New Haven, CT
| | - Jeffrey M Testani
- Sections of Cardiovascular Medicine (V.S.R., T.A., D.D.M., E.J.V., J.M.T.), Yale University School of Medicine, New Haven, CT
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Kaur P, Saxena N, You AX, Wong RCC, Lim CP, Loh SY, George PP. Effect of multimorbidity on survival of patients diagnosed with heart failure: a retrospective cohort study in Singapore. BMJ Open 2018; 8:e021291. [PMID: 29780030 PMCID: PMC5961600 DOI: 10.1136/bmjopen-2017-021291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Multimorbidity in patients with heart failure (HF) results in poor prognosis and is an increasing public health concern. We aim to examine the effect of multimorbidity focusing on type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) on all-cause and cardiovascular disease (CVD)-specific mortality among patients diagnosed with HF in Singapore. DESIGN Retrospective cohort study. SETTING Primary and tertiary care in three (out of six) Regional Health Systems in Singapore. PARTICIPANTS Patients diagnosed with HF between 2003 and 2016 from three restructured hospitals and nine primary care polyclinics were included in this retrospective cohort study. PRIMARY OUTCOMES All-cause mortality and CVD-specific mortality. RESULTS A total of 34 460 patients diagnosed with HF from 2003 to 2016 were included in this study and were followed up until 31 December 2016. The median follow-up time was 2.1 years. Comorbidities prior to HF diagnosis were considered. Patients were categorised as (1) HF only, (2) T2DM+HF, (3) CKD+HF and (4) T2DM+CKD+HF. Cox regression model was used to determine the effect of multimorbidity on (1) all-cause mortality and (2) CVD-specific mortality. Adjusting for demographics, other comorbidities, baseline treatment and duration of T2DM prior to HF diagnosis, 'T2DM+CKD+HF' patients had a 56% higher risk of all-cause mortality (HR: 1.56, 95% CI 1.48 to 1.63) and a 44% higher risk of CVD-specific mortality (HR: 1.44, 95% CI 1.32 to 1.56) compared with patients diagnosed with HF only. CONCLUSION All-cause and CVD-specific mortality risks increased with increasing multimorbidity. This study highlights the need for a new model of care that focuses on holistic patient management rather than disease management alone to improve survival among patients with HF with multimorbidity.
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Affiliation(s)
- Palvinder Kaur
- Health Services and Outcomes Research, National Healthcare Group, Singapore
| | - Nakul Saxena
- Health Services and Outcomes Research, National Healthcare Group, Singapore
| | - Alex Xiaobin You
- Health Services and Outcomes Research, National Healthcare Group, Singapore
| | - Raymond C C Wong
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Choon Pin Lim
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Seet Yoong Loh
- Department of Cardiology, Tan Tock Seng Hospital, Singapore
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Abstract
Heart failure is a growing epidemic, and our understanding of the intricacies of its pathophysiology continues to evolve. Over the last decade, biomarkers of heart failure have been extensively investigated, particularly for diagnosis and risk stratification. While the natriuretic peptides remain the gold standard heart failure biomarker, they are plagued by their non-specific nature; furthermore, the strategy of natriuretic peptide-guided care remains elusive. Multiple candidate markers indicative of other physiologic aspects of heart failure have been identified and studied, including soluble ST2, galectin-3, and high-sensitivity cardiac troponins. Each of these biomarkers has the potential to provide unique therapeutically relevant information. Ultimately, a multi-marker approach may be applied to improve care of patients with heart failure. Definitive clinical trials and the use of advanced statistical analytic techniques are needed to truly determine the optimal strategy of biomarker-assisted diagnosis, prognostication, and management of patients who suffer from this devastating condition.
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