Heart Failure in Patients with Chronic Kidney Disease: A Systematic Integrative Review

Abstract

Introduction. Heart failure (HF) is highly prevalent in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) and is strongly associated with mortality in these patients. However, the treatment of HF in this population is largely unclear. Study Design. We conducted a systematic integrative review of the literature to assess the current evidence of HF treatment in CKD patients, searching electronic databases in April 2014. Synthesis used narrative methods. Setting and Population. We focused on adults with a primary diagnosis of CKD and HF. Selection Criteria for Studies. We included studies of any design, quantitative or qualitative. Interventions. HF treatment was defined as any formal means taken to improve the symptoms of HF and/or the heart structure and function abnormalities. Outcomes. Measures of all kinds were considered of interest. Results. Of 1,439 results returned by database searches, 79 articles met inclusion criteria. A further 23 relevant articles were identified by hand searching. Conclusions. Control of fluid overload, the use of beta-blockers and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and optimization of dialysis appear to be the most important methods to treat HF in CKD and ESRD patients. Aldosterone antagonists and digitalis glycosides may additionally be considered; however, their use is associated with significant risks. The role of anemia correction, control of CKD-mineral and bone disorder, and cardiac resynchronization therapy are also discussed.

Eccentric Left Ventricular Hypertrophy and Sudden Death in Patients with End-Stage Kidney Disease

“…As for the prevalence of eccentric LVH, comparable findings were previously published by Paoletti et al [30] by studying 42 dialysis patients with LVH who suffered from 30 fatal and non-fatal cardiovascular events. Since eccentric LVH results particularly from volume expansion in ESKD [10,11], as suggested in our study by a slight, but significantly lower urinary output than individuals with concentric LVH and an extremely high PSLVWS, stringent fluid control may help in reducing mortality.…”

“…Apart from chronic activation of the sympathetic and renin-angiotensin-aldosterone system [32], which may lead to sodium and fluid retention and myocardial fibrosis [33], other risk factors seem to play a role as well. Traditional risk factors, however, such as hypercholesterolemia, hypertension and obesity cannot fully explain the poor clinical outcome in this patient group [11]. Therefore, non-traditional risk factors, including inflammation, oxidative stress, endothelial dysfunction and abnormalities in CKD mineral-bone disease have been implicated in the development of LVH, heart failure and death [34].…”

“…From a hemodynamic view, LVH is an adaptive remodeling process that compensates for the increase in cardiac workload induced by an increased afterload (pressure overload), an increased preload (volume overload) or both [9]. Generally, an increased afterload leads to concentric hypertrophy, while an increased preload leads to the development of eccentric hypertrophy [10,11]. Although there is considerable overlap between these two entities, the first has been related to diastolic dysfunction and the second to systolic dysfunction [12].…”

Community-Acquired Acute Kidney Injury as a Risk Factor of de novo Heart Failure Hospitalization

“…Among elderly Medicare beneficiaries (≥67 years), Ishani et al [24] documented that the risk of developing end stage renal disease after AKI was 13 times higher than for those without AKI. This is particularly concerning, as patients with end stage renal disease on dialysis have been shown to have >10 times the risk of cardiovascular mortality than individuals without CKD of the same age and gender [25]. This well-described phenomenon of a paired decline in renal and cardiac function is termed the cardiorenal syndrome [5].…”

Carvedilol as nephroprotective agent: a meta-analysis of randomized controlled trials

“…This is because patients of chronic kidney disease are at high risk of progression of renal failure in presence of heart failure and vice-versa. 22 Carvedilol and other beta-1 blockers were found to be non-inferior to other classes of antihypertensive drugs with regard to primary prevention of heart failure. 23 DHPs may not be superior with regard to primary prevention of heart failure.…”