Heart failure patients can tolerate small falls in kidney function as a side effect of treatments, new guidance has suggested.
Published in the journal Nephrology Dialysis Transplation, 'Management of heart failure in patients with kidney disease – updates from the 2021 ESC guidelines' recommends that most cases of heart failure should be treated by the rapid introduction of 4 ‘pillar’ drugs for heart failure that reduce mortality and hospitalisation.
In a major update since guidance published in 2016, there is now strong evidence that pillar drugs for heart failure actually preserve kidney function in the long term by slowing decline, despite observed initial reductions in function.
As a result, pillar drugs should not be stopped or reduced unless dangerous effects such as high potassium levels occur. Among the summary of the guidance, the authors also note that the use of pacing and defibrillator devices can be problematic in patients with end stage kidney disease.
The paper was a commissioned review of the 2021 updated European Society of Cardiology guidelines on heart failure in the journal of European Renal Association. It examines the new guidelines and draws to the attention of specialists in kidney disease those aspects of the heart failure guidelines that are most pertinent to their practice
Heart failure is a common problem caused by damage to the heart which reduces its pumping function. Frequently heart failure patients also develop impaired kidney function and need skilled and knowledgeable combined care from both heart failure and kidney failure specialists. These patients have had a high mortality and need for hospital treatment but their outlook is improving rapidly as newer treatments have been shown to be effective.
The lead author of the publication, Dr Nicola Edwards, who is now a Cardiologist at Green Lane Cardiovascular Service, Auckland, New Zealand, but is a former member of the Birmingham Cardio-Renal Group, said: “We were delighted to be able to provide this guidance which we hope will be a real asset to both nephrologists and heart failure specialists.”
Professor Jon Townend, senior author and Director of Clinical Research and Honorary Professor of Cardiology at the Institute of Cardiovascular Sciences, commented: “The latest guidelines from the European Society of Cardiology summarise some exciting new recommendations for treating patients with heart failure, notably recognising the long-term benefit of pillar drugs outweighs initial reduction in kidney function. As a result, clinicians can be confident that seeing a short-term drop in kidney function is not cause for reducing or stopping treatment.”
Cardiovascular disease remains a major cause of death in patients with chronic kidney disease. The Birmingham Cardio-Renal Group continue to undertake original research examining new methods of preventing heart problems in patients with kidney disease and are grateful to the British Heart Foundation and collaborators in the Institute of Cardiovascular Sciences, University of Birmingham for their continued funding and support.
