Mattia Arrigo1, Pietro E Cippà2, Alexandre Mebazaa3,4,5. 1. Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. mattia.arrigo@usz.ch. 2. Center for Regenerative Medicine and Stem Cell Research, University of Southern California, Los Angeles, CA, USA. 3. INSERM UMR-S 942, Paris, France. 4. University Paris Diderot, Sorbonne Paris Cité, Paris, France. 5. Department of Anesthesiology and Critical Care Medicine, St. Louis and Lariboisère University Hospitals, Paris, France.
Abstract
PURPOSE OF THE REVIEW: To summarize current advances in the understanding and management of heart failure (HF) in patients with advanced chronic kidney disease (CKD). RECENT FINDINGS: Diagnosis of HF and treatment of congestion are crucial in the management of patients with advanced CKD to reduce symptoms, preserve organ function, and improve outcomes. Echocardiography and cardiovascular biomarkers may help to differentiate cardiac from non-cardiac components of overhydration. Renal replacement therapy or ultrafiltration may be required to treat congestion. Furthermore, patients with advanced CKD are frequently undertreated with disease-modifying HF therapies, but the use of beta-blockers and ACEi should be considered under close monitoring of kidney function and serum potassium. The use of the new oral potassium binders may translate into improved outcomes. The treatment of HF in patients with advanced CKD requires a multi-disciplinary approach. New diagnostic and therapeutic strategies are under evaluation and may contribute to improved outcomes.
PURPOSE OF THE REVIEW: To summarize current advances in the understanding and management of heart failure (HF) in patients with advanced chronic kidney disease (CKD). RECENT FINDINGS: Diagnosis of HF and treatment of congestion are crucial in the management of patients with advanced CKD to reduce symptoms, preserve organ function, and improve outcomes. Echocardiography and cardiovascular biomarkers may help to differentiate cardiac from non-cardiac components of overhydration. Renal replacement therapy or ultrafiltration may be required to treat congestion. Furthermore, patients with advanced CKD are frequently undertreated with disease-modifying HF therapies, but the use of beta-blockers and ACEi should be considered under close monitoring of kidney function and serum potassium. The use of the new oral potassium binders may translate into improved outcomes. The treatment of HF in patients with advanced CKD requires a multi-disciplinary approach. New diagnostic and therapeutic strategies are under evaluation and may contribute to improved outcomes.
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