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Impact of advanced chronic kidney disease on therapeutic management of heart failure with reduced ejection fraction
Session:
Posters (Sessão 6 - Écran 1) - Insuficiência Cardíaca - vários
Speaker:
Jéni Quintal
Congress:
CPC 2023
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.7 Chronic Heart Failure - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Jéni Quintal; Sara Gonçalves; Tatiana Duarte; Rui Coelho; Pedro Carreira; Margarida Madeira; Hugo Viegas; Ana Sousa; Crisálida Ferreira; Andreia Soares; Dina Ferreira; Ana Natário; José Assunção; Ermelinda Pedroso; Rui Caria
Abstract
<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Background</strong>: Heart failure (HF) is a life-threatening syndrome that affects more than 64 million people worldwide. Chronic kidney disease (CKD) is a common comorbidity. Nevertheless, HF treatment trials have excluded patients (pts) in advanced stages of CKD. </span></span></p> <p style="text-align:justify"> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose</strong>: The aim of this study was to evaluate the impact of advanced CKD in HF with reduced ejection fraction (HFrEF) pts and CKD in HF management and outcomes.</span></span></p> <p style="text-align:justify"> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: We performed a retrospective single-center cohort study. Consecutive pts with HFrEF referred to a multidisciplinary HF unit, between 1 January and 31 December 2019 (n=85). We excluded pts without CKD (n=22). Patients were divided in 2 groups (g) according to CKD stage: gA (mild - CKD KDIGO stages 2 and 3a) and gB (advanced - CKD KDIGO stages 3b, 4 and 5). Groups were compared in terms of therapy instituted, dosages, adverse events (drug intolerance, hospitalization due to HF decompensation and all-cause mortality) and HF improvement (NYHA class (c), NT-proBNP and left ventricle EF (LVEF) difference) at 12m and at last medical follow-up (FUP).</span></span></p> <p style="text-align:justify"> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>This cohort included 63 pts: 40 in gA and 23 in gB). The overall mean age was 72 (<span style="font-family:Symbol">±</span>9.25) years. Patients in gB were older than those in gA (75<span style="font-family:Symbol">±</span>8.43 vs 70<span style="font-family:Symbol">±</span>9.27 years,p=0.030). The median FUP was 41m (Q1-Q3: 38-44). There were no differences regarding cardiovascular risk factors. The g were comparable in terms of NYHA <span style="color:black">c, </span>LVEF and HF etiology. Median NT-proBNP at admission was higher in gB (3538 vs 1487 pg/mL,p=0.009). </span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">There were no differences between g in the percentage (%) of pts under Angiotensin Converting Enzyme Inhibitors (ACEi)/ Angiotensin-II receptor antagonists (ARA-II)/ Angiotensin receptor-neprilysin inhibitor (ARNI) or B-blockers (BB), but Mineralocorticoid Receptor Antagonists (MRA) were more frequently used in gA (75.7 vs 33.3%,p=0.004) and SGLT2i more frequently used in gB (86.7 vs 45.9%,p=0.007) . The % of pts under target doses of BB (40.5 gA vs 53.3% gB) and ACEi/ARA-II/ARNI (59.5 gA vs gB 66.7%) were similar.</span></span></p> <p style="text-align:justify"> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Acute on CKD was more frequent in gB (30.4 vs 5.0%,p=0.009) but there were no differences between g regarding hypotension, bradycardia or hyperkalemia. Drug intolerance conditioning therapeutic changes were similar in both g. There was an improvement of NYHA c and in median levels of NT-proBNP in both g during FUP. Although LVEF variation was similar between the g, ICD implantation rate was higher in gB (21.7 vs 2.5%,p=0.020). There were no differences in hospitalization or mortality rates.</span></span></p> <p> </p> <p><strong><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">Conclusions: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">Advanced CKD in HFrEF pts was associated with a fewer use of MRA and a greater use of SLGT2i. Although acute deterioration of CKD was more frequent in advanced CKD pts, HF therapy was well tolerated with no increase in discontinuation rates. Despite the scarce evidence of these classes in pts with HF and advanced CKD, HF therapy was associated with a similar improvement in functional capacity and LV function.</span></span></p>
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