Dataset Information

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

ABSTRACT:

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.

SUBMITTER: Segall L

PROVIDER: S-EPMC4052068 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Publications

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

Segall Liviu L Nistor Ionut I Covic Adrian A

BioMed research international 20140515

<h4>Introduction</h4>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.<h4>Study design</h4>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.<h4> ...[more]

PMID: 24959595

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Project description:BackgroundThe prevalence and mortality of heart failure with preserved ejection fraction (HFpEF) are high in patients with chronic kidney disease (CKD). However, there is still a lack of recommendations for the medication therapy of these patients in the guideline so far.MethodsWe conducted a systematic review and meta-analysis of all the studies assessing medication therapy for patients with CKD and HFpEF by July 21, 2021. Pooled analysis was performed using a random-effect model and the quality assessment was performed. In our research, we followed to the Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The meta-analysis was registered on PROSPERO.ResultsWe finally identified six studies, three of which were randomized controlled trials and the others were retrospective cohort studies. The results of meta-analysis including three retrospective cohort studies showed that renin-angiotensin system inhibitors had significantly reduced all-cause mortality by 14% (3 studies, 3816 patients, HR 0.86; 95% CI 0.79-0.95; I2 = 49%; P = 0.003), and all-cause hospitalization by 11% (2 studies, 2350 patients, HR 0.89; 95% CI 0.85-0.94; I2 = 0%; P < 0.00001) in patients with CKD and HFpEF. However, there was no significant reduction in the risk of hospitalization for heart failure (3 studies, 3816 patients, HR 0.88; 95% CI 0.75-1.04; I2 = 75%; P = 0.13). One of the studies focused on the sacubitril-valsartan showed that sacubitril-valsartan was associated with a reduced risk of hospitalization for heart failure and cardiovascular death (RR 0.79, 95% CI 0.66-0.95). The study focused on the carvedilol did not show a significant reduction in the risk of hospitalization for heart failure and cardiovascular death (HR 0.917, 95% CI 0.501-1.678).ConclusionsFor patients with CKD and HFpEF, renin-angiotensin system inhibitors is associated with significant benefits in all-cause mortality and all-cause hospitalization but has no significant effect on hospitalization for heart failure. The subgroup analysis of one RCT study focused on ARNI showed that although long-term treatment with sacubitril-valsartan may reduce the risk of hospitalization for heart failure and cardiovascular death, more studies are needed to confirm that.

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Dataset Information

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

Introduction

Study design

Setting and population

Selection criteria for studies

Interventions

Outcomes

Results

Conclusions

Publications

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

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