P6251Prognostic value of ACEi/ARBS in elderly patients with heart failure with reduced ejection fraction with and without chronic kidney disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Martinez Milla ◽  
M Cortes ◽  
M Lopez-Castillo ◽  
A Devesa ◽  
A L Rivero-Monteagudo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Left Ventricular Ejection ◽  
Hospital Records ◽  
Patients With Heart Failure ◽  
The Mean

Abstract Introduction Angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers therapy (ACEI/ARB) have shown to reduce mortality in patients with heart failure and reduced left ventricular ejection fraction (HFrEF). However, there is lack of information about the benefit of these drugs in patients with chronic kidney disease (CKD), and even less in elderly patients. Our aim is to compare the prognostic impact of ACE/ARB if CKD is present or not Methods From January 2008 to July 2014, we consecutively enlisted 802 patients aged >75 years that had ejection fraction ≤35%. Clinical, echocardiographic and ECG data were taken from hospital records. Follow-up was made via telephone and hospital records as well. We analyzed the relationship between treatment with ACEi/ARBs (with different doses) and occurrence of mortality or MACE (major adverse cardiovascular events: composite of death from any cause or hospitalization for heart failure). Results From the total population 410 (51%) patients that had not CKD (glomerular filtration rate (GFR) >60ml/min/1,73m2) and 390 (49%) patients had CKD (with GFR ≤60ml/min/1,73m2). We analyze the population according the presence or not of CKD. Both groups had similar characteristics except the age: 81.5±4.5 years vs. 82.6±4.1 (p<0.05) and the percentage of use of ACEi/ARB 78.8% of the total vs 66.9% of the total (p<0.05). The mean ejection fraction was 27.9±6.5% vs 28.12±6.5% (p>0.05). The mean follow up was 33±22 vs 32±23 months (p>0.05). In patients with no CKD 170 (42%) patients died and 239 (58%) patients had a MACE. In the CKD group 211 (54.1%)patients died and 257 (65.9%)patients had a major cardiovascular event. In the univariate analysis in both groups the use of ACEi/ARB reduced the mortality and the MACE. After a multivariate analysis ACEi/ARB appear to be beneficial in the CKD group (OR 0.71 [0.50–0.98]) but not in no CKD group Conclusions According to our data, treatment with ACEI/ARB in elderly patients HFrEF and CKD should be encouraged even more than in those without CKD.

Beta-blockers in elderly patients with left ventricular systolic dysfunction and chronic kidney disease: danger or benefit?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Martinez Milla ◽  
M Cortes ◽  
M Lopez-Castillo ◽  
A Devesa-Arbiol ◽  
A.L Rivero-Monteagudo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Propensity Score ◽  
Ejection Fraction ◽  
Beta Blockers ◽  
Hospital Records ◽  
Propensity Score Matching Analysis ◽  
The Mean

Abstract Introduction Beta-blockers (BB) have been shown to reduce mortality in patients with HFrEF. However, there is little data on the benefit of these therapies in patients with chronic kidney disease and even less in older patients. The aim of this work is to evaluate the role of beta-blockers in patients ≥75 years along the spectrum of kidney disease. Methods From January 2008 to July 2014, we consecutively enlisted 802 patients aged &gt;75 years that had ejection fraction ≤35%. From this group we included 380 patients that had CKD (defined as a glomerular filtration rate (GFR) ≤60 ml/min/1.73m2). Clinical, echocardiographic and electrocardiographic data were taken from hospital records. Follow-up was made via telephone and hospital records as well. Propensity score matching analysis was made to assess the relationship between treatment with BB and occurrence of major adverse cardiovascular event (MACE) composite of death for any cause or heart failure. hospitalization. Multivariate Cox regression analysis was also made in the different groups of CKD (45–60 ml/min/1.73m2, 30–45 ml/min/1.73m2, &lt;30 ml/min/1.73m2) in order to assess the effect of BB over mortality and CV events in each subgroup. Results 390 patients were included. Male represented 62.3% of all participants, and the mean age was 82.6±4.1 years. The mean ejection fraction was 27.9±6.5%. Ischemic etiology was found in 50.6% of cases. Glomerular filtrate (GF) was 60 to 45 ml/min/1.73 m2 in 50.3% of patients, 45–30 ml/min/1.73 m2 in 37.4% and &lt;30 ml/min/1.73 m2 in 12.3%. At the end of the follow-up, 67.4% of the patients were on beta-blocker treatment. The mean follow-up was 32±23 months. During the study period, 211 patients (54.1%) died and 257 patients (65.9%) had a major cardiovascular event (death or hospitalization for heart failure). After propensity score matching analysis, 178 were considered (89 each group) and they have no significant difference in baseline characteristics. BBs were found to significantly reduce mortality (HR 0.45 (95% CI, 0.27–0.75). When the effect of BB over the different subgroups of CKD was analyzed, it was seen also that BB reduced mortality in patients with eGFR 45–60 ml/min/1.73 m2 (HR 0.47 (95% CI, 0.26–0.86), in patients with eGFR 30–45 ml/min/1.73 m2 (HR 0.55 (95% CI, 0.26–1.06)and in eGFR &lt;30 ml/min/1.73 m2 (HR 0.29 (95% CI, 0.11–0.76) Conclusion The use of beta-blockers in elderly patients with HFrEF and kidney DISEASE was associated with increased survival, regardless of the degree of kidney failure. There is a need to raise awareness of the benefits of beta-blocker use in these patients to promote their use where possible. Funding Acknowledgement Type of funding source: None

scholarly journals 633 Efficacy of additional medical therapies in patients with heart failure, reduced ejection fraction, and chronic kidney disease already receiving neurohormonal inhibitors: a network meta-analysis

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Vincenzo De Marzo ◽  
Lucia Tricarico ◽  
Giuseppe Biondi Zoccai ◽  
Michele Correale ◽  
Natale Daniele Brunetti ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Ejection Fraction ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Composite Outcome ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure

Abstract Aims We assessed the efficacy of add-on drugs in patients with heart failure with reduced ejection fraction (HFrEF) and concomitant chronic kidney disease (CKD) already receiving neurohormonal inhibition (NEUi). Methods and results The literature was systematically searched for phase 3 randomized controlled trials (RCTs) involving ≥90% patients with left ventricular ejection fraction &lt;45%, of whom &lt;30% were acutely decompensated, and with published information about the subgroup of estimated glomerular filtration rate &lt;60 ml/min/1.73 m2. Six RCTs were included in a study-level network meta-analysis evaluating the effect of NEUi, ivabradine, angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter-2 inhibitors (SGLT2i), vericiguat, and omecamtiv mecarbil (OM) on a composite outcome of cardiovascular death or hospitalization for heart failure. In a fixed-effects model, SGLT2i (HR: 0.78, 95% CrI: 0.69–0.89), ARNI (HR: 0.79, 95% CrI: 0.69–0.90), and ivabradine (HR: 0.82, 95% CrI: 0.69–0.98) decreased the risk of the composite outcome vs. NEUi, whereas OM did not (HR: 0.98, 95% CrI: 0.89–1.10). A trend for improved outcome was also found for vericiguat (HR: 0.90, 95% CrI: 0.80–1.00). In indirect comparisons, both SLGT2i (HR: 0.80, 95% CrI: 0.68–0.94) and ARNI (HR: 0.80, 95% CrI: 0.68–0.95) reduced the risk vs. OM; furthermore, there was a trend for a greater benefit of SGLT2i vs. vericiguat (HR: 0.88, 95% CrI: 0.73–1.00) and ivabradine vs. OM (HR: 0.84, 95% CrI: 0.68–1.00). Results were comparable in a random-effects model and in sensitivity analyses. SUCRA scores were 81.8%, 80.8%, 68.9%, 44.2%, 16.6%, and 7.8% for SGLT2i, ARNI, ivabradine, vericiguat, OM, and NEUi, respectively. Conclusions Expanding pharmacotherapy beyond NEUi improves outcomes in HFrEF with CKD. 633 Figure

Heart Failure with Recovered Ejection Fraction in a Cohort of Elderly Patients with Chronic Heart Failure

Cardiology ◽  
2016 ◽  
Vol 135 (3) ◽  
pp. 196-201 ◽  
Author(s):  
Joan Carles Trullàs ◽  
Luís Manzano ◽  
Francesc Formiga ◽  
Oscar Aramburu-Bodas ◽  
María Angustias Quesada-Simón ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Hazard Ratios ◽  
Patients With Heart Failure ◽  
Pharmacologic Management

Objective: The aim of this study was to determine whether patients with heart failure (HF) who recover left ventricular ejection fraction (LVEF), termed here as ‘Rec-HF', have a distinct clinical profile and prognosis compared with patients with HF and reduced LVEF (HF-REF) or HF and preserved LVEF (HF-PEF). Methods: We evaluated and classified patients from the Spanish Heart Failure Registry into three categories based on enrollment/follow-up echocardiograms: HF-PEF (LVEF ≥50%), HF-REF (LVEF persistently <50%) and Rec-HF (LVEF on enrollment <50% but normalized during follow-up). Results: A total of 1,202 patients were included, 1,094 with HF-PEF, 81 with HF-REF and 27 with Rec-HF. The three groups included patients of advanced age (mean age 75 years) with comorbidities. Rec-HF patients were younger, with a better functional status, lower prevalence of diabetes mellitus, dementia and cerebrovascular disease, and higher prevalence of COPD. The etiology of HF was more frequently ischemic and alcoholic and less frequently hypertensive. After a median follow-up of 367 days, the unadjusted hazard ratios for death in the Rec-HF versus HF-PEF and HF-REF groups were 0.11 (95% CI 0.02-080; p = 0.029) and 0.31 (95% CI 0.04-2.5; p = 0.274). Results were statistically nonsignificant in multivariate-adjusted models. Conclusion: Rec-HF is also present in elderly patients with HF but it is necessary to further investigate the natural history and optimal pharmacologic management of this ‘new HF syndrome'.

scholarly journals Plasma natriuretic peptide level is an independent determinant of major clinical outcomes in atrial fibrillation patients without heart failure: the Fushimi AF Registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Hamatani ◽  
M Iguchi ◽  
Y Aono ◽  
K Ishigami ◽  
S Ikeda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Outcomes ◽  
Prognostic Marker ◽  
Oral Anticoagulants ◽  
Systemic Embolism ◽  
The Mean

Abstract Background Atrial fibrillation (AF) increases the risk of death, stroke/systemic embolism and heart failure (HF). Plasma natriuretic peptide (NP) level is an important prognostic marker in HF patients. However, little is known regarding the prognostic significance of plasma NP level in AF patients without HF. Purpose The aim of this study is to investigate the relationship between plasma NP level and clinical outcomes such as all-cause death, stroke/systemic embolism and HF hospitalization during follow-up period in AF patients without HF. Methods The Fushimi AF Registry is a community-based prospective survey of AF patients in our city. The inclusion criterion of the registry is the documentation of AF at 12-lead electrocardiogram or Holter monitoring at any time, and there are no exclusion criteria. We started to enroll patients from March 2011, and follow-up data were available for 4,466 patients by the end of November 2019. From the registry, we excluded 1,220 patients without a pre-existing HF (defined as having one of the following; prior hospitalization for HF, New York Heart Association class ≥2, or left ventricular ejection fraction &lt;40%). Among 3,246 AF patients without HF, we investigated 1,189 patients with the data of plasma BNP (n=401) or N-terminal pro-BNP (n=788) level at the enrollment. We divided the patients according to the quartile of each plasma BNP or NT-pro BNP level and compared the backgrounds and outcomes between these 4 groups stratified by plasma NP level. Results Of 1,189 patients, the mean age was 72.1±10.2 years, 454 (38%) were female and 684 (58%) were paroxysmal AF. The mean CHADS2 and CHA2DS2-VASc score were 1.6±1.1 and 2.9±1.5, respectively. Oral anticoagulants were prescribed in 671 (56%) at baseline. The median (interquartile range) BNP and N-terminal pro-BNP level were 84 (38, 176) and 500 (155, 984) pg/ml, respectively. Patients with high plasma NP level were older, and demonstrated lower prevalence of paroxysmal AF, higher CHADS2 and CHA2DS2-VASc scores and higher prevalence of chronic kidney disease and oral anticoagulants prescription (all P&lt;0.01). A total of 165 all-cause death, 114 stroke/systemic embolism and 103 HF hospitalization occurred during the median follow-up period of 5.0 years. Kaplan-Meier curves demonstrated that higher plasma NP level was significantly associated with the incidences of all-cause death, stroke/systemic embolism and HF hospitalization in AF patients without HF (Figure 1A). Multivariable Cox regression analysis revealed that plasma NP level could stratify the risk of clinical outcomes even after adjustment by type of AF, CHA2DS2-VASc score, chronic kidney disease and oral anticoagulant prescription (Figure 1B). Conclusion Plasma NP level is a significant prognostic marker for all-cause death, stroke/systemic embolism and HF hospitalization in AF patients without HF, suggesting the importance of measuring plasma NP level in AF patients even without HF. Figure 1 Funding Acknowledgement Type of funding source: None

Abstract P232: Screening Past B-Type Natriuretic Peptide (BNP) Values to Identify Candidates for Treatment of Systolic Dysfunction

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Parisa Gholami ◽  
Shoutzu Lin ◽  
Paul Heidenreich
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Significant Difference ◽  
The Mean

Background: BNP testing is now common though it is not clear if the test results are used to improve patient care. A high BNP may be an indicator that the left ventricular ejection fraction (LVEF) is low (<40%) such that the patient will benefit from life-prolonging therapy. Objective: To determine how often clinicians obtained a measure of LVEF (echocardiography, nuclear) following a high BNP value when the left ventricular ejection fraction (LVEF) was not known to be low (<40%). Methods and Results: We reviewed the medical records of 296 consecutive patients (inpatient or outpatient) with a BNP values of at least 200 pg/ml at a single medical center (tertiary hospital with 8 community clinics). A prior diagnosis of heart failure was made in 65%, while 42% had diabetes, 79% had hypertension, 59% had ischemic heart disease and 31% had chronic lung disease. The mean age was 73 ± 12 years, 75% were white, 10% black, 15% other and the mean BNP was 810 ± 814 pg/ml. The LVEF was known to be < 40% in 84 patients (28%, mean BNP value of 1094 ± 969 pg/ml). Of the remaining 212 patients without a known low LVEF, 161 (76%) had a prior LVEF >=40% ( mean BNP value of 673 ± 635 pg/ml), and 51 (24%) had no prior LVEF documented (mean BNP 775 ± 926 pg/ml). Following the high BNP, a measure of LVEF was obtained (including outside studies documented by the primary care provider) within 6 months in only 53% (113 of 212) of those with an LVEF not known to be low. Of those with a follow-up echocardiogram, the LVEF was <40% in 18/113 (16%) and >=40% in 95/113 (84%). There was no significant difference in mean initial BNP values between those with a follow-up LVEF <40% (872 ± 940pg/ml), >=40% (704 ± 737 pg/ml), or not done (661 ± 649 pg/ml, p=0.5). Conclusions: Follow-up measures of LVEF did not occur in almost 50% of patients with a high BNP where the information may have led to institution of life-prolonging therapy. Of those that did have a follow-up study a new diagnosis of depressesd LVEF was noted in 16%. Screening of existing BNP and LVEF data and may be an efficient strategy to identify patients that may benefit from life-prolonging therapy for heart failure.

scholarly journals SO057BETA-BLOCKERS ARE ASSOCIATED WITH REDUCED MORTALITY IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION AND ADVANCED CHRONIC KIDNEY DISEASE: COHORT STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Edouard L Fu ◽  
Alicia Uijl ◽  
Friedo W Dekker ◽  
Lars H Lund ◽  
Gianluigi Savarese ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Ejection Fraction ◽  
Beta Blocker ◽  
Beta Blockers ◽  
Advanced Chronic Kidney Disease ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
All Cause Mortality

Abstract Background and Aims Beta-blockers reduce mortality and morbidity in patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, patients with advanced chronic kidney disease (CKD) were underrepresented in landmark trials. We evaluated if beta-blockers are associated with improved survival in patients with HFrEF and advanced CKD. Method We identified 3906 persons with an ejection fraction &lt;40% and advanced CKD (eGFR &lt;30 mL/min/1.73m2) enrolled in the Swedish Heart Failure Registry during 2001-2016. The associations between beta-blocker use, 5-year all-cause mortality, and the composite of time to cardiovascular (CV) mortality/first HF hospitalization were assessed by multivariable Cox regression. Analyses were adjusted for 36 variables, including demographics, laboratory measures, comorbidities, medication use, medical procedures, and socioeconomic status. To assess consistency, the same analyses were performed in a positive control cohort of 12,673 patients with moderate CKD (eGFR &lt;60-30 mL/min/1.73m2). Results The majority (89%) of individuals with HFrEF and advanced CKD received treatment with beta-blockers. Median (IQR) age was 81 (74-86) years, 36% were women and median eGFR was 26 (20-28) mL/min/173m2. During 5 years of follow-up, 2086 (53.4%) individuals had a subsequent HF hospitalization, and 2954 (75.6%) individuals died, of which 2089 (70.1%) due to cardiovascular causes. Beta-blocker use was associated with a significant reduction in 5-year all-cause mortality [adjusted hazard ratio (HR) 0.86; 95% confidence interval (CI) 0.76-0.96)] and CV mortality/HF hospitalization (HR 0.87; 95% CI 0.77-0.98). The magnitude of the associations between beta-blocker use and outcomes was similar to that observed for HFrEF patients with mild/moderate CKD, with adjusted HRs for all-cause mortality and CV mortality/HF hospitalization of 0.85 (95% CI 0.78-0.91) and 0.88 (95% CI 0.82-0.96), respectively. Conclusion Despite lack of trial evidence, the use of beta-blockers in patients with HFrEF and advanced CKD was high in routine Swedish care, and was independently associated with reduced mortality to the same degree as HFrEF with moderate CKD.

Leg flow-mediated arterial dilation in elderly patients with heart failure and normal left ventricular ejection fraction

2007 ◽  
Vol 292 (3) ◽  
pp. H1427-H1434 ◽  
Author(s):  
W. Gregory Hundley ◽  
Ersin Bayram ◽  
Craig A. Hamilton ◽  
Eric A. Hamilton ◽  
Timothy M. Morgan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Normal Left Ventricular ◽  
Patients With Heart Failure

Background: flow-mediated arterial dilation (FMAD), an indicator of endothelial function, is reduced in patients with heart failure and reduced left ventricular ejection fraction (HFREF). Many elderly patients with heart failure exhibit a normal left ventricular ejection fraction (HFNEF). It is unknown whether FMAD is severely reduced in the elderly with HFNEF. Methods and Results: 30 participants >60 yr of age, 11 healthy, 9 with HFNEF, and 10 with HFREF, underwent a cardiovascular magnetic resonance (CMR) assessment of FMAD in the superficial femoral artery followed within 48 h by symptom-limited exercise with expired gas analysis. Elderly patients with HFREF and HFNEF had severely reduced peak oxygen consumption (V̇o2 peak; 12 ± 2 and 13 ± 1 ml·kg−1·min−1, respectively) vs. their healthy age-matched contemporaries (20 ± 3 ml·kg−1·min−1). FMAD was 3.8 ± 1.3% (0.85 ± 0.22 mm2) in patients with HFREF; it was 12.1 ± 3.6% (3.1 ± 1.2 mm2) and 13.7 ± 5.9% (3.9 ± 1.7 mm2), respectively, in patients with HFNEF and age-matched healthy older individuals. After adjustment for age and gender, the association of FMAD with V̇o2 was high in healthy and HFREF subjects ( P = 0.05 and 0.02, respectively) but less so in HFNEF participants ( P = 0.58). Conclusions: elderly patients with HFNEF do not exhibit marked reduction in leg FMAD. These data suggest that mechanisms other than impaired femoral arterial endothelial function contribute to the severe exercise intolerance experienced by these individuals.

scholarly journals The risks and benefits of spironolactone use in heart failure with a reduced left ventricular ejection fraction and chronic kidney disease

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
O Obertynska
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Left Ventricular Ejection Fraction ◽  
Kidney Disease ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Public Institution ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Abstract Purpose Mineralocorticoid receptor antagonists (MRAs) remain underused in cases of heart failure with a reduced left ventricular ejection fraction (HFrEF) and chronic kidney disease (CKD), largely due to the fear of inducing worsening of renal function (RF) and hyperkalemia (HK), particularly in combination with renin angiotensin inhibitors. The aim was to investigate the safety use of spironolactone (SP) in patients with HFrEF (ejection fraction &lt;40%) and CKD and determine predictors of worsening of RF and developing HK. Methods 208 patients with HFrEF (on top of standard therapy including ACE-I or an ARB) and CKD (baseline eGFR between 30 and 60 ml/min) were included in the study. The potassium (K) and creatinine (C) levels, plasma aldosterone (AS) and NT-proBNP were estimated at baseline and at week 12. After biochemical evaluation, 101 patients started on SP treatment with a median dose of 23 mg daily (titrated). K and RF were checked at weeks 1, 2, 4, 6, 8, 12. Results K and C levels increased significantly after start of SP: mean K levels increased from 4.47±0.59 to 5.23±0.57 mEq/l, (P&lt;0.01) and was dose dependent. After 12 weeks of treatment the incidence of severe HK (K+ ≥6.0 mmol/L) was &lt;5%, K 5.5–5.9 mmol/L occurred in 13 patients (13%) and it was predicted by baseline eGFR≤35 ml/min/1.73 m2. and K ≥5.0 mmol/L/. Subsequently, these patients required a prescription of K binders. Mean eGFR on SP decreased from 48.34±2.23 to 42.19±2.65 ml/min/1.73 m2 (P&lt;0.01) and a significant decrease in GFR was observed only during the first month (P &lt;0.01) with not significant increasing to 6 and 12 weeks after the start of SP. Five patients (5%) on SP experienced significant decline of RF result in withdrew SP. Age, NT-proBNP concentration &gt;1550 ng/L and eGFR ≤35 ml/min/1.73 m2 at baseline had modest discriminative powers for predicting decline of RF (0.456, P&lt;0.01; 0.542, P&lt;0.001; 0.712, P&lt;0.001; respectively). At baseline in patients with HFrEF was an inverse correlation between GFR and NT-proBNP level (r=−0.298, p&lt;0.001). The SP treatment resulted in significantly reduced NT-proBNP and AS (P&lt;0.01; P&lt;0.05 respectively). By linear regression analysis in SP group the eGFR was associated with NT-proBNP change (0.362, P&lt;0.05). Conclusion In patient with HFrEF and CKD the risk-benefit ratio of spironolactone with respect to renal failure appears favourable due to improvement of the neurohumoral profile. Although the renal disfunction and hyperkalemia on spironolactone are common: approximately 18% patients required the prescription of K binders and 5% required the withdrew SP duo to decline RF, the occurrence of hyperkalemia was predicted by baseline potassium level and eGFR. Age, higher level of NT-proBNP and eGFR were identified as potential predictors of worsening of RF. So, caution should be advised when using spironolactone in HFrEF with CKD and potassium of ≥5.0 mmol/L and eGFR ≤35 ml/min/1.73 m2 and NT-proBNP concentration &gt;1550 ng/L for safety reasons. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): National Medical University

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