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Abstract
ABSTRACT
Despite the high prevalence of chronic kidney disease (CKD) and its high cardiovascular risk, patients with CKD, especially those with advanced CKD (stages 4–5 and patients on kidney replacement therapy), are excluded from most cardiovascular clinical trials. It is particularly relevant in patients with advanced CKD and heart failure (HF) who have been underrepresented in many pivotal randomized trials that have modified the management of HF. For this reason, there is little or no direct evidence for HF therapies in patients with advanced CKD and treatment is extrapolated from patients without CKD or patients with earlier CKD stages. The major consequence of the lack of direct evidence is the under-prescription of HF drugs to this patient population. As patients with advanced CKD and HF represent probably the highest cardiovascular risk population, the exclusion of these patients from HF trials is a serious deontological fault that must be solved. There is an urgent need to generate evidence on how to treat HF in patients with advanced CKD. This article briefly reviews the management challenges posed by HF in patients with CKD and proposes a road map to address them.
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Details
1 Division of Nephrology IIS-Fundacion Jimenez Diaz, Department of Medicine, Universidad Autónoma de Madrid , Madrid , Spain
2 RICORS2040, Carlos III Institute of Health , Madrid , Spain
3 Division of Cardiology, University Hospital, INCLIVA, Universitat de Valencia , Valencia , Spain
4 Centro de Investigación Biomédica en Red de las Enfermedades Cardiovasculares, Carlos III Institute of Health , Madrid , Spain
5 Department of Nephrology, University Hospital Infanta Leonor, University Complutense of Madrid , Madrid , Spain