Highlights
- •Long-term mortality remains high in heart failure patients with reduced EF and CKD.
- •RAS inhibitors are associated with lower mortality in stage 3B CKD patients.
- •A relation between the agents and prognosis is unclear in stage 4 or 5 CKD patients.
Abstract
Purpose
Although guidelines recommend that patients with heart failure with reduced ejection
fraction (HFrEF) should be treated with renin-angiotensin system (RAS) inhibitors,
the long-term efficacy of RAS inhibitors in HFrEF patients with moderate-to-severe
chronic kidney disease (CKD) remains unclear.
Methods
The present study included consecutive patients hospitalized for acute heart failure
across five Japanese teaching hospitals. The impact of RAS inhibitors on 2-year all-cause
mortality was evaluated in patients with an ejection fraction ≤40% and CKD, defined
as an estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2, at discharge. Its severity was subclassified from 3B to 5 according to eGFR.
Results
Overall, 553 patients (age, 76 ± 11 years; 68% male) were included. RAS inhibitors
were prescribed more frequently in 227 patients with stage 3B (71.2%) than in 107
patients with stage 4 or 5 CKD (45.7%). All-cause mortality was recorded in 119 patients
(23.4%) (55 [18.5%] patients with stage 3B; 64 [30.3%] patients with stage 4 or 5
CKD), within the median follow-up period of 609 (220–983) days. After many-to-one
propensity score matching (87 pairs in stage 3; 60 pairs in stage 4 or 5 CKD), those
with RAS inhibitors had reduced mortality rate in stage 3B (hazard ratio [HR], 0.39;
95% confidence interval [CI], 0.19–0.83) but not in stage 4 or 5 CKD (HR, 1.08; 95%
CI, 0.57–2.03).
Conclusions
In HFrEF patients with CKD, RAS inhibitors are associated with reduction in mortality
in stage 3B CKD, but the association is less clear in stage 4 or 5 CKD.
Keywords
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Article info
Publication history
Published online: February 05, 2019
Accepted:
January 29,
2019
Received in revised form:
January 18,
2019
Received:
September 27,
2018
Identification
Copyright
© 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
