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Cobo Marcos M, de la Espriella R, Gayán Ordás J, Llàcer P, Pomares A, Fort A, Ponz de Antonio I, Méndez A, Blázquez-Bermejo Z, Caravaca Pérez P, Rubio Gracia J, Recio-Mayoral A, Zegrí I, García Pinilla JM, Montero Hernández E, Castro A, Soler MJ, Górriz JL, Bascompte Claret R, Fluvià-Brugués P, Manzano L, Núñez J. Prevalence and clinical profile of kidney disease in patients with chronic heart failure. Insights from the Spanish cardiorenal registry. Rev Esp Cardiol (Engl Ed) 2024; 77:50-59. [PMID: 37217135 DOI: 10.1016/j.rec.2023.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/05/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION AND OBJECTIVES Patients with combined heart failure (HF) and chronic kidney disease (CKD) have been underrepresented in clinical trials. The prevalence of CKD in these patients and their clinical profile require constant evaluation. This study aimed to analyze the prevalence of CKD, its clinical profile, and patterns of use of evidence-based medical therapies in HF across CKD stages in a contemporary cohort of ambulatory patients with HF. METHODS From October 2021 to February 2022, the CARDIOREN registry included 1107 ambulatory HF patients from 13 HF clinics in Spain. RESULTS The median age was 75 years, 63% were male, and 48% had heart failure with reduced left ventricular ejection fraction (HFrEF). A total of 654 (59.1%) had an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, and 122 (11%) patients with eGFR ≥ 60 mL/min/1.73 m2 had a urine albumin-creatinin ratio ≥ 30 mg/g. The most important variables associated with lower eGFR were age (R2=61%) and furosemide dose (R2=21%). The proportion of patients receiving an angiotensin-converting enzyme inhibitor (ACEI)/ angiotensin II receptor blockers (ARB), an angiotensin receptor-neprilysin inhibitor (ARNi), a sodium-glucose cotransporter 2 inhibitor (SGLT2i), or a mineralocorticoid receptor antagonist (MRA) progressively decreased with lower eGFR categories. Notably, 32% of the patients with HFrEF and an eGFR <30 mL/min/1.73 m2 received the combination of ACEI/ARB/ARNi+beta-blockers+MRA+SGLT2i. CONCLUSIONS In this contemporary HF registry, 70% of patients had kidney disease. Although this population is less likely to receive evidence-based therapies, structured and specialized follow-up approaches within HF clinics may facilitate the adoption of these life-saving drugs.
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Affiliation(s)
- Marta Cobo Marcos
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHISA), Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Rafael de la Espriella
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Jara Gayán Ordás
- Servicio de Cardiología, Hospital Universitario Arnau de Vilanova. Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | - Pau Llàcer
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Antonia Pomares
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Aleix Fort
- Servicio de Cardiología, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | | | - Ana Méndez
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | | | - Jorge Rubio Gracia
- Servicio de Medicina Interna, Hospital Universitario Lozano Blesa, University of Zaragoza, Zaragoza, Spain
| | | | - Isabel Zegrí
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Esther Montero Hernández
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro (IDIPHISA), Majadahonda, Madrid, Spain
| | - Almudena Castro
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - María José Soler
- Servicio de Nefrología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - José Luis Górriz
- Servicio de Nefrología, Hospital Clínico Universitario Valencia (INCLIVA), University of Valencia, Valencia, Spain
| | - Ramón Bascompte Claret
- Servicio de Cardiología, Hospital Universitario Arnau de Vilanova. Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | | | - Luis Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Julio Núñez
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
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