Changes in Kidney Function Following Heart Failure Treatment: Focus on Renin–Angiotensin System Blockade

Abstract

Increased activation of the renin–angiotensin system (RAS) results in adverse cardiovascular effects, so therapies which block RAS are beneficial in this setting. Overall, ACE inhibitors have shown a significant reduction in death, MI, and hospital admission for HF. ARBs reduce morbidity and mortality in HF patients and can be used safely in patients intolerant of ACEI and, when used in this setting, provide a similar benefit to ACEI. There are no solid data to support combination of ACEI and ARB in heart failure. In contrast, the ACEI and ARB combination is beneficial for additional reductions in proteinuria among those with advanced proteinuric kidney disease. Trials with spironolactone (aldactone) showed a 30% reduction in the risk of death among patients in the spironolactone group. Renal dysfunction seen with either an ACE inhibitor or angiotensin receptor blocker (ARB) is directly proportional to the level of cardiac dysfunction. Hence, the lower the ejection fraction the greater the initial increase in serum creatinine. However, as cardiac function improves serum creatinine will start to fall.