scholarly journals Chronic kidney disease, heart failure and neprilysin inhibition

2019 ◽  
Vol 35 (4) ◽  
pp. 558-564 ◽  
Author(s):  
Richard Haynes ◽  
Doreen Zhu ◽  
Parminder K Judge ◽  
William G Herrington ◽  
Philip A Kalra ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Cardiac Biomarkers ◽  
Function Allocation ◽  
Increased Risk ◽  
Patients With Heart Failure ◽  
Neprilysin Inhibition ◽  
The Uk

Abstract Patients with chronic kidney disease are at increased risk of cardiovascular disease and this often manifests clinically like heart failure. Conversely, patients with heart failure frequently have reduced kidney function. The links between the kidneys and cardiovascular system are being elucidated, with blood pressure being a key risk factor. Patients with heart failure have benefitted from many trials which have now established a strong evidence based on which to base management. However, patients with advanced kidney disease have often been excluded from these trials. Nevertheless, there is little evidence that the benefits of such treatments are modified by the presence or absence of kidney disease, but more direct evidence among patients with advanced kidney disease is required. Neprilysin inhibition is the most recent treatment to be shown to improve outcomes among patients with heart failure. The UK HARP-III trial assessed whether neprilysin inhibition improved kidney function in the short- to medium-term and its effects on cardiovascular biomarkers. Although no effect (compared to irbesartan control) was found on kidney function, allocation to neprilysin inhibition (sacubitril/valsartan) did reduce cardiac biomarkers more than irbesartan, suggesting that this treatment might improve cardiovascular outcomes in this population. Larger clinical outcomes trials are needed to test this hypothesis.

scholarly journals Angiotensin-Neprilysin Inhibition and Renal Outcomes in Heart Failure With Preserved Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (13) ◽  
pp. 1236-1245 ◽  
Author(s):  
Finnian R. Mc Causland ◽  
Martin P. Lefkowitz ◽  
Brian Claggett ◽  
Nagesh S. Anavekar ◽  
Michele Senni ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Ejection Fraction ◽  
Renal Outcome ◽  
Preserved Ejection Fraction ◽  
Double Blind ◽  
Prospective Comparison ◽  
Patients With Heart Failure ◽  
Neprilysin Inhibition

Background: In patients with heart failure, chronic kidney disease is common and associated with a higher risk of renal events than in patients without chronic kidney disease. We assessed the renal effects of angiotensin/neprilysin inhibition in patients who have heart failure with preserved ejection fraction enrolled in the PARAGON-HF trial (Prospective Comparison of ARNI With ARB Global Outcomes in HF With Preserved Ejection Fraction). Methods: In this randomized, double-blind, event-driven trial, we assigned 4822 patients who had heart failure with preserved ejection fraction to receive sacubitril/valsartan (n=2419) or valsartan (n=2403). Herein, we present the results of the prespecified renal composite outcome (time to first occurrence of either: ≥50% reduction in estimated glomerular filtration rate (eGFR), end-stage renal disease, or death from renal causes), the individual components of this composite, and the influence of therapy on eGFR slope. Results: At randomization, eGFR was 63±19 mL·min –1 ·1.73 m – 2. At study closure, the composite renal outcome occurred in 33 patients (1.4%) assigned to sacubitril/valsartan and 64 patients (2.7%) assigned to valsartan (hazard ratio, 0.50 [95% CI, 0.33–0.77]; P =0.001). The treatment effect on the composite renal end point did not differ according to the baseline eGFR (<60 versus ≥60 mL·min –1 ·1.73 m –2 ( P -interaction=0.92). The decline in eGFR was less for sacubitril/valsartan than for valsartan (–2.0 [95% CI, –2.2 to –1.9] versus –2.7 [95% CI, –2.8 to –2.5] mL·min –1 ·1.73 m –2 per year). Conclusions: In patients with heart failure with preserved ejection fraction, sacubitril/valsartan reduced the risk of renal events, and slowed decline in eGFR, in comparison with valsartan. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01920711.

scholarly journals Outcome trends in people with heart failure, type 2 diabetes mellitus and chronic kidney disease in the UK over twenty years

2021 ◽  
Vol 32 ◽  
pp. 100739
Author(s):  
Claire A Lawson ◽  
Samuel Seidu ◽  
Francesco Zaccardi ◽  
Gerry McCann ◽  
Umesh T Kadam ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Type 2 Diabetes Mellitus ◽  
Kidney Disease ◽  
Failure Type ◽  
The Uk

eGFR Variability in Patients with Heart Failure and Chronic Kidney Disease

2021 ◽  
Author(s):  
Aaron M. Hein ◽  
Julia J. Scialla ◽  
Jie-Lena Sun ◽  
Stephen J. Greene ◽  
Linda K. Shaw ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Patients With Heart Failure

scholarly journals Clinical effect of long-term administration of tolvaptan in patients with heart failure and chronic kidney disease

2018 ◽  
Vol 12 (3) ◽  
pp. 154-160
Author(s):  
Yohei Ono ◽  
Hiroto Takamatsu ◽  
Masahiro Inoue ◽  
Yukio Mabuchi ◽  
Tetsuya Ueda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Effect ◽  
Patients With Heart Failure ◽  
Term Administration

What practice nurses need to know about the NICE chronic kidney disease guidelines

2021 ◽  
Vol 32 (12) ◽  
pp. 468-472
Author(s):  
Peter Ellis
Keyword(s):  
Chronic Kidney Disease ◽  
General Practice ◽  
Kidney Disease ◽  
Kidney Function ◽  
Practice Nurse ◽  
Nice Guidelines ◽  
Practice Nurses ◽  
Health Related ◽  
The Uk

Chronic kidney disease is highly prevalent in the community. Peter Ellis looks at the role of the practice nurse in diagnosing and managing chronic kidney disease in general practice Chronic kidney disease (CKD) is defined as a reduction in kidney function, or damage to kidney structure, which has persisted for greater than 3 months and which is associated with other health-related issues. While there are many causes of CKD, the most prevalent in western societies, including the UK, are diabetes and hypertension. This article identifies the role of the practice nurse in applying the National Institute for Health and Care Excellence (NICE) guidelines for CKD.

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