Management of Heart Failure With Reduced Ejection Fraction in Patients With Diabetes Mellitus and Chronic Kidney Disease

Autores da FMUP

• João Pedro Melo Marques Pinho Ferreira

  Autor

Participantes de fora da FMUP

• Khan M.S.
• Rashid A.M.
• Shafi T.
• Butler J.

Unidades de investigação

• Cirurgia e Fisiologia

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

Heart failure (HF), diabetes, and chronic kidney disease (CKD) frequently coexist, with one comorbidity worsening the prognosis of another. ß-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. © 2023 Elsevier Inc.

Keywords

• Angiotensin Receptor Antagonists; Angiotensins; Diabetes Mellitus; Heart Failure; Humans; Mineralocorticoid Receptor Antagonists; Renal Insufficiency, Chronic; Sodium-Glucose Transporter 2 Inhibitors; Stroke Volume; bisoprolol; bumetanide; creatinine; dapagliflozin; empagliflozin; enalapril; eplerenone; metoprolol; nebivolol; sacubitril plus valsartan; spironolactone; torasemide; valsartan; angiotensin derivative; angiotensin receptor antagonist; mineralocorticoid antagonist; sodium glucose cotransporter 2 inhibitor; aging; all cause mortality; cardiovascular mortality; chronic kidney failure; comorbidity; creatinine blood level; diabetes mellitus; drug efficacy; estimated glomerular filtration rate; frailty; heart failure with reduced ejection fraction; high risk patient; human; hyperkalemia; kidney failure; mortality risk; Review; risk reduction; chronic kidney failure; complication; diabetes mellitus; heart failure; heart stroke volume; physiology