Author:
Quiroga Borja,Ortiz Alberto,Núñez Sara,Kislikova Maria,González Sanchidrián Silvia,Broseta José Jesús,Albines Zoila Stany,Escamilla Cabrera Beatriz,Rivero Viera Yaiza,Rodriguez Santarelli David,Salanova Villanueva Laura,Lopez Rodriguez Francisca,Cancho Castellano Barbara,Ibáñez Cerezon María,Gutierrez Rivas Carmen Patricia,Aresté Nuria,Campos Gutiérrez Belén,Ródenas Gálvez Ana,Glucksmann Pizá Maria Constanza,Balda Manzanos Sagrario,Soldevila Amparo,Rodríguez Gayo Lucía,Moral Berrio Esperanza,Ortega Diaz Mayra,Beltrán Catalán Sandra,Puente García Adriana,Ángel Rojas Miguel,Sosa Barrios R. Haridian,Santana Zapatero Henar,Rangel Hidalgo Gema,Martinez Canet Ana Maria,Díez Javier,
Abstract
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 (BB), mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter-2 inhibitors (SGLT2i).
Results. Among 5012 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.