Heart failure in patients with chronic kidney disease: a systematic integrative review.

INTRODUCTION

Heart failure (HF) is highly prevalent in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) and is strongly associated with mortality in these patients. However, the treatment of HF in this population is largely unclear.

STUDY DESIGN

We conducted a systematic integrative review of the literature to assess the current evidence of HF treatment in CKD patients, searching electronic databases in April 2014. Synthesis used narrative methods.

SETTING AND POPULATION

We focused on adults with a primary diagnosis of CKD and HF.

SELECTION CRITERIA FOR STUDIES

We included studies of any design, quantitative or qualitative.

INTERVENTIONS

HF treatment was defined as any formal means taken to improve the symptoms of HF and/or the heart structure and function abnormalities.

OUTCOMES

Measures of all kinds were considered of interest.

RESULTS

Of 1,439 results returned by database searches, 79 articles met inclusion criteria. A further 23 relevant articles were identified by hand searching.

CONCLUSIONS

Control of fluid overload, the use of beta-blockers and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and optimization of dialysis appear to be the most important methods to treat HF in CKD and ESRD patients. Aldosterone antagonists and digitalis glycosides may additionally be considered; however, their use is associated with significant risks. The role of anemia correction, control of CKD-mineral and bone disorder, and cardiac resynchronization therapy are also discussed.