Enachi Stefana, Schleef Maxime, Hadjseyd Chahr-Eddine, Leboube Simon, Fauvel Charles, Daniel Lucie, Jobbe-Duval Antoine, Sebbag Laurent, Lemoine Sandrine, Mewton Nathan
Heart Failure Department, Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, Lyon, France.
Department of Nephrology and Renal Function, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
Curr Heart Fail Rep. 2023 Apr;20(2):101-112. doi: 10.1007/s11897-023-00594-1. Epub 2023 Feb 28.
Chronic kidney disease (CKD) is highly prevalent in patients with heart failure and reduced ejection fraction (HFrEF), representing a major factor of adverse outcomes. In clinical practice, it is one of the main reasons for not initiating, not titrating, and even withdrawing efficient heart failure drug therapies in patients.
Despite limited data, studies show that HFrEF therapies maintain their benefits on cardiovascular outcomes in patients with CKD. Most HF drugs cause acute renal haemodynamic changes, but with stabilisation or even improvement after the acute phase, thus with no long-term worsening of the renal function. In this expert opinion-based paper, we challenge the pathophysiology misunderstandings that impede HF disease-modifying therapy implementation in this setting and propose a strategy for HF drug titration in patients with moderate, severe, and end-stage chronic kidney disease.
慢性肾脏病（CKD）在射血分数降低的心力衰竭（HFrEF）患者中高度流行，是不良结局的主要因素。在临床实践中，它是患者未启动、未滴定甚至停用有效心力衰竭药物治疗的主要原因之一。
尽管数据有限，但研究表明，HFrEF治疗对CKD患者的心血管结局仍有益处。大多数心力衰竭药物会引起急性肾血流动力学变化，但在急性期后会稳定甚至改善，因此不会导致肾功能长期恶化。在这篇基于专家意见的论文中，我们对阻碍在这种情况下实施心力衰竭疾病改善治疗的病理生理学误解提出质疑，并提出了针对中度、重度和终末期慢性肾脏病患者进行心力衰竭药物滴定的策略。
