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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.