Managing Heart Failure With Reduced Ejection Fraction in Patients With Chronic Kidney Disease: A Case-Based Approach and Contemporary Review
Source : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486859/
The pharmacologic management of heart failure with reduced ejection fraction (HFrEF) is well established. Contemporary foundational treatment of HFrEF includes the following 4 standard therapies: (i) a renin-angiotensin system (RAS) inhibitor (eg, an angiotensin-converting enzyme inhibitor [ACEI], angiotensin receptor blocker [ARB], or angiotensin receptor-neprilysin inhibitor); (ii) a ß-blocker; (iii) a mineralocorticoid receptor antagonist (MRA); and (iv) a sodium-glucose cotransporter 2 (SGLT2) inhibitor.
Conclusion/Relevance: The sodium-glucose cotransporter 2 inhibitors are effective at reducing adverse cardiovascular and renal outcomes in patients with HFrEF and CKD (eGFR ≥ 25 mL/min per 1.73 m2 with dapagliflozin or ≥ 20 mL/min per 1.73 m2 with empagliflozin), although declining kidney function is a risk, due to the osmotic diuretic effect. Finally, mineralocorticoid receptor antagonist therapy should be considered in all patients with HFrEF and an eGFR ≥ 30 mL/min per 1.73 m2. The starting dose should be low (eg, 6.25-12.5 mg daily or 12.5 mg every other day) and can be uptitrated based on the patient’s renal function and serum potassium.