TY - JOUR
T1 - Management of Heart Failure With Reduced Ejection Fraction in Patients With Diabetes Mellitus and Chronic Kidney Disease
AU - Khan, Muhammad Shahzeb
AU - Rashid, Ahmed Mustafa
AU - Shafi, Tariq
AU - Ferreira, Joao Pedro
AU - Butler, Javed
N1 - Funding Information:
Financial support: Editorial assistance in the form of formatting of the article according to the journal's instructions to authors and drafting of Figure 2 for inclusion with the revised final draft was provided by Charlotte Maddocks of Envision Pharma Group, funded by Bayer Corporation. No assistance was provided in the writing, fact/data checking, or development of any draft, including the final draft for publication; other than that stated above, the authors were solely responsible for the content.
Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/5
Y1 - 2023/5
N2 - Heart failure (HF), diabetes, and chronic kidney disease (CKD) frequently coexist, with one comorbidity worsening the prognosis of another. β-blockers, angiotensin-receptor–neprilysin inhibitors, renin-angiotensin-aldosterone system inhibitors, mineralocorticoid-receptor antagonists, and sodium-glucose cotransporter-2 inhibitors all have been shown to reduce mortality in patients with HF with reduced ejection fraction. However, their uptake in real-world clinical practice remains low, especially among patients who have multiple other comorbidities such as CKD and diabetes. The management of HF in patients with diabetes and CKD can be especially challenging because these patients typically are older, frail, and have multiple other comorbidities, and guideline-directed medical therapy used in HF potentially can affect renal function acutely and chronically. In this article, we discuss the available evidence for each of the foundational HF therapies in patients with diabetes and CKD, emphasizing the current challenges and outlining future directions to optimize the management of HF among these high-risk patients.
AB - Heart failure (HF), diabetes, and chronic kidney disease (CKD) frequently coexist, with one comorbidity worsening the prognosis of another. β-blockers, angiotensin-receptor–neprilysin inhibitors, renin-angiotensin-aldosterone system inhibitors, mineralocorticoid-receptor antagonists, and sodium-glucose cotransporter-2 inhibitors all have been shown to reduce mortality in patients with HF with reduced ejection fraction. However, their uptake in real-world clinical practice remains low, especially among patients who have multiple other comorbidities such as CKD and diabetes. The management of HF in patients with diabetes and CKD can be especially challenging because these patients typically are older, frail, and have multiple other comorbidities, and guideline-directed medical therapy used in HF potentially can affect renal function acutely and chronically. In this article, we discuss the available evidence for each of the foundational HF therapies in patients with diabetes and CKD, emphasizing the current challenges and outlining future directions to optimize the management of HF among these high-risk patients.
KW - Heart failure
KW - chronic kidney disease
KW - diabetes mellitus
KW - guideline-directed medical therapy
KW - Humans
KW - Heart Failure/complications
KW - Stroke Volume/physiology
KW - Mineralocorticoid Receptor Antagonists/therapeutic use
KW - Renal Insufficiency, Chronic/complications
KW - Sodium-Glucose Transporter 2 Inhibitors/therapeutic use
KW - Diabetes Mellitus/drug therapy
KW - Angiotensins/therapeutic use
KW - Angiotensin Receptor Antagonists/therapeutic use
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U2 - 10.1016/j.semnephrol.2023.151429
DO - 10.1016/j.semnephrol.2023.151429
M3 - Review article
C2 - 37871362
AN - SCOPUS:85174461171
SN - 0270-9295
VL - 43
SP - 151429
JO - Seminars in nephrology
JF - Seminars in nephrology
IS - 3
M1 - 151429
ER -