Treatment of Chronic Heart Failure in Advanced Chronic Kidney Disease: The HAKA Multicenter Retrospective Real-World Study
Introduction: Chronic heart failure (HF) has high rates of mortality and hospitalization in patients with advanced chronic kidney disease (aCKD). However, randomized clinical trials have systematically excluded aCKD population. We have investigated current HF therapy in patients receiving clinical c...
| Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2024 |
| País: | España |
| Institución: | Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO) |
| Repositorio: | r-FISABIO. Repositorio Institucional de Producción Científica |
| OAI Identifier: | oai:fisabio.fundanetsuite.com:p16992 |
| Acceso en línea: | https://fisabio.portalinvestigacion.com/publicaciones/16992 |
| Access Level: | acceso abierto |
| Palabra clave: | Advanced chronic kidney disease Cardiorenal syndrome Chronic heart failure Heart failure therapy |
| Sumario: | Introduction: Chronic heart failure (HF) has high rates of mortality and hospitalization in patients with advanced chronic kidney disease (aCKD). However, randomized clinical trials have systematically excluded aCKD population. We have investigated current HF therapy in patients receiving clinical care in specialized aCKD units. Methods: The Heart And Kidney Audit (HAKA) was a cross-sectional and retrospective real-world study including outpatients with aCKD and HF from 29 Spanish centers. The objective was to evaluate how the treatment of HF in patients with aCKD complied with the recommendations of the European Society of Cardiology Guidelines for the diagnosis and treatment of HF, especially regarding the foundational drugs: renin-angiotensin system inhibitors (RASi), angiotensin receptor blocker/neprilysin inhibitors (ARNI), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter-2 inhibitors (SGLT2i). Results: Among 5,012 aCKD patients, 532 (13%) had a diagnosis of HF. Of them, 20% had reduced ejection fraction (HFrEF), 13% mildly reduced EF (HFmrEF), and 67% preserved EF (HFpEF). Only 9.3% of patients with HFrEF were receiving quadruple therapy with RASi/ARNI, BB, MRA, and SGLT2i, but the majority were not on the maximum recommended doses. None of the patients with HFrEF and CKD G5 received quadruple therapy. Among HFmrEF patients, approximately half and two-thirds were receiving RASi and/or BB, respectively, while less than 15% received ARNI, MRA, or SGLT2i. Less than 10% of patients with HFpEF were receiving SGLT2i. Conclusions: Under real-world conditions, HF in aCKD patients is sub-optimally treated. Increased awareness of current guidelines and pragmatic trials specifically enrolling these patients represent unmet medical needs. Patients with advanced chronic kidney disease (aCKD) and heart failure (HF) are at high risk of poor outcomes including premature death and hospitalization. However, evidence on their management is scarce. Many pivotal clinical trials testing HF treatments have excluded patients with aCKD and there is a paucity of real-world data on the diagnosis and treatment of these patients. The cross-sectional and retrospective HAKA study has some novel findings. On the one hand, the large range in the prevalence of HF between centers suggests an underdiagnosed of HF in patients with aCKD cared for in some specialized aCKD units. On the other hand, foundational HF medications are markedly underprescribed in patients with HFrEF. The HAKA study results justify a call to action for clinicians to optimize the diagnosis and treatment of HF in patients with aCKD. In addition, they support that appropriate evidence-based pharmacological treatment of HF in patients with aCKD is an unmet medical need that urgently requires specific clinical trials. |
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