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.

Details

Title
The unmet need of evidence-based therapy for patients with advanced chronic kidney disease and heart failure
Author
Ortiz, Alberto 1 ; Navarro-González, Juan F 2 ; Núñez, Julio 3 ; de la Espriella, Rafael 3 ; Cobo, Marta 4 ; Santamaría, Rafael 2 ; de Sequera, Patricia 5 ; Díez, Javier 4 

 Division of Nephrology IIS-Fundacion Jimenez Diaz, Department of Medicine, Universidad Autónoma de Madrid , Madrid , Spain 
 RICORS2040, Carlos III Institute of Health , Madrid , Spain 
 Division of Cardiology, University Hospital, INCLIVA, Universitat de Valencia , Valencia , Spain 
 Centro de Investigación Biomédica en Red de las Enfermedades Cardiovasculares, Carlos III Institute of Health , Madrid , Spain 
 Department of Nephrology, University Hospital Infanta Leonor, University Complutense of Madrid , Madrid , Spain 
Pages
865-872
Publication year
2022
Publication date
May 2022
Publisher
Oxford University Press
ISSN
20488505
e-ISSN
20488513
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3169586741
Copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of the ERA. This work is published under https://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.