Abstract: SA-PO925
Maximisation of Renin-Angiotensin-Aldosterone System Inhibition (RAASi) in CKD Patients with Heart Failure (HF): Experience from a CKD-HF Clinic
Session Information
- CKD: Clinical, Outcomes, Trials - III
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Nguyen, Mai, St Georges University Hospital NHS Foundation Trust, London, United Kingdom
- Rumjaun, Samir A., St Georges University Hospital NHS Foundation Trust, London, United Kingdom
- Banerjee, Debasish, St Georges Hospital and St Georges University of London, Wimbledon, LOndon, United Kingdom
Background
CKD-HF patients suffer from high hospitalisation and mortality rates, which may improve with maximum RAASi- often avoided by physicians due to fear of worsening renal function and hyperkalaemia. This study reports impact of a novel multidisciplinary cardiology-nephrology clinic for RAASi maximisation in CKD-HF patients.
Methods
Clinical, biochemical data and medications were obtained from electronic patient records and clinical letters on 97 patients seen and followed up in CKD-HF clinic from 23/03/17 to 11/04/19. Daily doses of each medication were classified into None, Low, Medium (≥50% maximum dose) and Maximum dose. Medication dose groups and blood test results were compared between the first and last clinic visit.
Results
Patient characteristics were: median age 78.5 years (IQR 66.8-84.3 years), male 71.1%, diabetes mellitus 53.6%, mean ejection fraction (EF) 38.6±13.7%, HFrEF 48.5% and CKD stages 3 (56.7%), 4&5 (43.3%). Median follow up time was 302 days (IQR 178-479 days). 15 patients died during follow up. At the end of follow up: 78.4% patients remained same or milder CKD group.
There was a difference in the number of RAASi patients were on, between first and last visit (p=0.02): none (41.2% vs 29.9%), one (45.4% vs 50.5%), both ACEi/ARB and MRA (13.4% vs 19.6%).
ACEi/ARB dose was increased in 33.0% patients and MRA dose in 17.5% of patients. Proportion of patients on each dose category between first and last visit for ACEi/ARB was not different (p=0.11): none (45.4% vs 39.2%), low dose (26.8% vs 26.8%), medium dose (16.5% vs 20.6%), maximum dose (11.3% vs 13.4%); for MRAs, it was different (p=0.02): none (82.5% vs 71.1%), low dose (7.2% vs 13.4%), medium dose (10.3% vs 12.4%), maximum dose (0% vs 3.1%).
There was no change in serum Na, K, creatinine in patients with ACEi/ARB or MRA dose increase between first and last visit. The change of eGFR was significant in patients with MRA dose increase (p=0.03), however, it was small (34.5 vs 32.1 ml/min/1.73m2). There was no significant correlation between RAASi dose increase and the likelihood of patients having CKD progression (p=0.64 for ACEi/ARB; p=0.66 for MRA).
Conclusion
A combined CKD-HF clinic was effective in maximising RAAS inhibition in a high-risk group of patients without clinically significant hyperkalaemia or deterioration in renal function.