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Challenges and Opportunities in Titrating Disease-Modifying Therapies in Heart Failure with Reduced Ejection Fraction and Chronic Kidney Disease

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Abstract

Purpose of Review

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.

Recent Findings

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.

Summary

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.

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Authors and Affiliations

  1. Heart Failure Department, Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, Lyon, France

    Stefana Enachi, Chahr-Eddine Hadjseyd, Simon Leboube, Lucie Daniel, Antoine Jobbe-Duval, Laurent Sebbag & Nathan Mewton

  2. Department of Nephrology and Renal Function, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France

    Maxime Schleef & Sandrine Lemoine

  3. Clinical Investigation Center INSERM 1407, Université Claude Bernard Lyon 1, 69500, Bron, France

    Maxime Schleef, Simon Leboube, Sandrine Lemoine & Nathan Mewton

  4. Department of Cardiology, FHU Carnaval, Rouen University Hospital, Rouen, France

    Charles Fauvel

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  1. Stefana Enachi
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Stefana Enachi, Chahreddine Hadjseyd, Lucie Daniel and Sandrine Lemoine declare no competing interests. Maxime Schleef reports grants from Hospices Civils de Lyon, outside the submitted work. Charles Fauvel reports personal fees from Janssen and grants from Pfizer, outside the submitted work. Nathan Mewton and Laurent Sebbag report personal fees from Bayer, Novartis, Astra Zeneca, Boehringer Ingelheim and Vifor Pharma outside of the submitted work. Antoine Jobbe Duval reports personal fees from Amicus, Bohringer Ingelheim, Novartis and Astra Zeneca and personal fees and non-financial support from Pfizer and Sanofi, outside the submitted work.

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Enachi, S., Schleef, M., Hadjseyd, CE. et al. Challenges and Opportunities in Titrating Disease-Modifying Therapies in Heart Failure with Reduced Ejection Fraction and Chronic Kidney Disease. Curr Heart Fail Rep 20, 101–112 (2023). https://doi.org/10.1007/s11897-023-00594-1

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