ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Abstract: FR-PO486

The Use of Renin-Angiotensin System Inhibitors and Aldosterone Receptor Antagonists in Heart Failure Patients with CKD

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Ghetiya, Shreya, Jersey Shore University Medical Center, Neptune, New Jersey, United States
  • Kalathil, Sheila, Jersey Shore University Medical Center, Neptune, New Jersey, United States
  • Obagi, Aref, Jersey Shore University Medical Center, Neptune, New Jersey, United States
  • Mccourt, Kimberly J, Jersey Shore University Medical Center, Neptune, New Jersey, United States
  • Asif, Arif, Jersey Shore University Medical Center, Neptune, New Jersey, United States
  • Calderon, Dawn, Jersey Shore University Medical Center, Neptune, New Jersey, United States
Background

In order to reduce morbidity and mortality, ACCF/AHA guidelines for heart failure with reduced ejection fraction (HFrEF), (EF≤40%), recommend angiotensin converting enzyme inhibitors (ACE-I) unless contraindicated (c/i) . Angiotensin Receptor Blockers (ARBs) should be used in those pts who are intolerant to ACEIs. In those pts who are tolerant to ACEIs/ARBs, ACC/AHA 2016 updated guideline recommends replacing it with Angiotensin-Receptor/Neprilysin inhibitor (ARNI) to further reduce mortality. Guideline also recommend to add Aldosterone receptor antagonists (ARA) in all pts with NYHA class II-IV and who have EF ≤35% , or EF ≤40% with MI/diabetes who develop symptom, unless c/i.

Methods

We conducted a retrospective chart review of 118 patients with EF≤40% discharged from our tertiary care hospital between 01/2016-12/2016 to ascertain if the guidelines were met. Prevalence of stage 3 chronic kidney disease (eGFR<60) and proteinuria were also measured.

Results

Demographics revealed that out of 118 pts evaluated, 68% were male and 80% were White, 16% Black, 2% Hispanic,1% Asian, and 1% others. Only 69 (58%) were on ACEIs/ARBs/ARNI and 61 (52%) were on ARA upon discharge. Of these 69 pts, 41(59%) were on ACEIs, 12(17%) on ARBs and 16(23.18%) on ARNI. 5 pts (7.24%) were switched to ARNI from ACEIs/ARBs upon discharge. 35pts(30%) had c/i to ACEIs/ARBs/ARNIs and 29 pts (24%) had c/i to ARA. In this cohort, 67 pts (57%) had CKD 3. The average eGFR was 35.74ml/min/1.73m2. Proteinuria was present in 35 pts (30%) of all 118 and 21(31%) out of 67 pts with CKD. Average serum sodium and potassium upon discharge were 136.7 and 4.14 mmol/l, respectively. Hyperkalemia (>=5.0mmol/l) was found in only 8(7%) pts. Average EF was 25%. Average SBP: 117mmHg and DBP: 671mmHg.

Conclusion

This analysis reveals opportunity for improvement in the utilization of ACEACEIs/ARBs/ARNI and ARA, both for cardiac and renal benefits.