Skip to main content
SpringerLink
Log in

A Patient with Progressive Renal Insufficiency in Chronic Heart Failure with Reduced Ejection Fraction

  • Chapter
  • First Online:
Cardiorenal Syndrome in Heart Failure

  • 983 Accesses

Abstract

Renal insufficiency is a frequent comorbidity found in heart failure patients with reduced ejection fraction (HFREF). It is associated with hemodynamic alterations in HFREF, including reduced renal perfusion and venous congestion. When present, it poses significant challenges to clinicians treating these patients. Although evidence is lacking regarding their safety and efficacy when renal insufficiency is severe, it is plausible common evidence based therapies retain their beneficial effects, which may actually be larger considering absolute risk reductions. However, the downside is an increased risk of adverse events, counterbalancing possible beneficial effects. Care should be taken to evaluate each individual HFREF patients with renal dysfunction, including serial monitoring of renal function, carefully selecting, monitoring and uptitrating medical treatment and minimizing the risk for adverse events.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. WRITING COMMITTEE MEMBERS, Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):e240–327.

    Google Scholar 

  2. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Card Fail. 2017;23(8):628–51.

    Article  Google Scholar 

  3. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200.

    Article  Google Scholar 

  4. van Deursen VM, Damman K, van der Meer P, Wijkstra PJ, Luijckx GJ, van Beek A, et al. Co-morbidities in heart failure. Heart Fail Rev. 2014;19(2):163–72.

    Article  CAS  Google Scholar 

  5. Kajimoto K, Sato N, Takano T, investigators of the Acute Decompensated Heart Failure Syndromes (ATTEND) registry. Relationship of renal insufficiency and clinical features or comorbidities with clinical outcome in patients hospitalised for acute heart failure syndromes. Eur Heart J Acute Cardiovasc Care. 2017;6(8):697–708.

    Article  Google Scholar 

  6. Damman K, Valente MA, Voors AA, O’Connor CM, Van Veldhuisen DJ, Hillege HL. Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis. Eur Heart J. 2014;35(1522-9645; 0195-668; 7):455–69.

    Article  Google Scholar 

  7. Mentz RJ, Kelly JP, von Lueder TG, Voors AA, Lam CS, Cowie MR, et al. Noncardiac comorbidities in heart failure with reduced versus preserved ejection fraction. J Am Coll Cardiol. 2014;64(21):2281–93.

    Article  Google Scholar 

  8. Damman K, Testani JM. The kidney in heart failure: an update. Eur Heart J. 2015;36(23):1437–44.

    Article  Google Scholar 

  9. Smith GL, Lichtman JH, Bracken MB, Shlipak MG, Phillips CO, DiCapua P, et al. Renal impairment and outcomes in heart failure: systematic review and meta-analysis. J Am Coll Cardiol. 2006;47(1558-3597; 0735-1097; 10):1987–96.

    Article  Google Scholar 

  10. Dries DL, Exner DV, Domanski MJ, Greenberg B, Stevenson LW. The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction. J Am Coll Cardiol. 2000;35(0735-1097; 0735-1097; 3):681–9.

    Article  CAS  Google Scholar 

  11. Hillege HL, Girbes AR, de Kam PJ, Boomsma F, De ZD, Charlesworth A, et al. Renal function, neurohormonal activation, and survival in patients with chronic heart failure. Circulation. 2000;102(1524-4539; 0009-7322; 2):203–10.

    Article  CAS  Google Scholar 

  12. Ronco C, Haapio M, House AA, Anavekar N, Bellomo R. Cardiorenal syndrome. J Am Coll Cardiol. 2008;52(1558-3597; 19):1527–39.

    Article  Google Scholar 

  13. Bongartz LG, Cramer MJ, Doevendans PA, Joles JA, Braam B. The severe cardiorenal syndrome: ‘Guyton revisited’. Eur Heart J. 2005;26(0195-668; 0195-668; 1):11–7.

    Article  Google Scholar 

  14. Smilde TD, Damman K, van der Harst P, Navis G, Daan Westenbrink B, Voors AA, et al. Differential associations between renal function and “modifiable” risk factors in patients with chronic heart failure. Clin Res Cardiol. 2009;98(1861-0692; 2):121–9.

    Article  CAS  Google Scholar 

  15. Damman K, van Deursen VM, Navis G, Voors AA, Van Veldhuisen DJ, Hillege HL. Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease. J Am Coll Cardiol. 2009;53(1558-3597; 0735-1097; 7):582–8.

    Article  Google Scholar 

  16. Ljungman S, Laragh JH, Cody RJ. Role of the kidney in congestive heart failure. Relationship of cardiac index to kidney function. Drugs. 1990;39 Suppl 4(0012-6667; 0012-6667):10–21.

    Article  CAS  Google Scholar 

  17. Mullens W, Abrahams Z, Francis GS, Sokos G, Taylor DO, Starling RC, et al. Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol. 2009;53(1558-3597; 7):589–96.

    Article  Google Scholar 

  18. Damman K, Navis G, Smilde TD, Voors AA, van der Bij W, van Veldhuisen DJ, et al. Decreased cardiac output, venous congestion and the association with renal impairment in patients with cardiac dysfunction. Eur J Heart Fail. 2007;9(1388-9842; 9):872–8.

    Article  Google Scholar 

  19. Burnett JC Jr, Knox FG. Renal interstitial pressure and sodium excretion during renal vein constriction. Am J Physiol. 1980;238(0002-9513; 0002-9513; 4):F279–82.

    CAS  PubMed  Google Scholar 

  20. Fiksen-Olsen MJ, Strick DM, Hawley H, Romero JC. Renal effects of angiotensin II inhibition during increases in renal venous pressure. Hypertension. 1992;19(0194-911; 2):137–41.

    Google Scholar 

  21. Damman K, Tang WH, Testani JM, McMurray JJ. Terminology and definition of changes renal function in heart failure. Eur Heart J. 2014;35(48):3413–6.

    Article  CAS  Google Scholar 

  22. Verbrugge FH, Dupont M, Steels P, Grieten L, Swennen Q, Tang WH, et al. The kidney in congestive heart failure: ‘are natriuresis, sodium, and diuretics really the good, the bad and the ugly?’. Eur J Heart Fail. 2014;16(2):133–42.

    Article  CAS  Google Scholar 

  23. Halbesma N, Brantsma AH, Bakker SJ, Jansen DF, Stolk RP, De ZD, et al. Gender differences in predictors of the decline of renal function in the general population. Kidney Int. 2008;74(1523-1755; 0085-2538; 4):505–12.

    Article  Google Scholar 

  24. James MT, Grams ME, Woodward M, Elley CR, Green JA, Wheeler DC, et al. A meta-analysis of the association of estimated GFR, albuminuria, diabetes mellitus, and hypertension with acute kidney injury. Am J Kidney Dis. 2015;66(4):602–12.

    Article  Google Scholar 

  25. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296–305.

    Article  CAS  Google Scholar 

  26. Anders HJ, Huber TB, Isermann B, Schiffer M. CKD in diabetes: diabetic kidney disease versus nondiabetic kidney disease. Nat Rev Nephrol. 2018;14(6):361–77.

    Article  CAS  Google Scholar 

  27. Tonneijck L, Muskiet MH, Smits MM, van Bommel EJ, Heerspink HJ, van Raalte DH, et al. Glomerular hyperfiltration in diabetes: mechanisms, clinical significance, and treatment. J Am Soc Nephrol. 2017;28(4):1023–39.

    Article  CAS  Google Scholar 

  28. Hoy WE, Hughson MD, Bertram JF, Douglas-Denton R, Amann K. Nephron number, hypertension, renal disease, and renal failure. J Am Soc Nephrol. 2005;16(9):2557–64.

    Article  Google Scholar 

  29. Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure. JAMA. 1996;275(20):1557–62.

    Article  CAS  Google Scholar 

  30. Damman K, Tang WH, Felker GM, Lassus J, Zannad F, Krum H, et al. Current evidence on treatment of patients with chronic systolic heart failure and renal insufficiency: practical considerations from published data. J Am Coll Cardiol. 2014;63(1558-3597; 0735-1097; 9):853–71.

    Article  Google Scholar 

  31. Vardeny O, Wu DH, Desai A, Rossignol P, Zannad F, Pitt B, et al. Influence of baseline and worsening renal function on efficacy of spironolactone in patients with severe heart failure: insights from RALES (Randomized Aldactone Evaluation Study). J Am Coll Cardiol. 2012;60(1558-3597; 0735-1097; 20):2082–9.

    Article  CAS  Google Scholar 

  32. Rossignol P, Dobre D, McMurray JJ, Swedberg K, Krum H, van Veldhuisen DJ, et al. Incidence, determinants, and prognostic significance of hyperkalemia and worsening renal function in patients with heart failure receiving the mineralocorticoid receptor antagonist eplerenone or placebo in addition to optimal medical therapy: results from the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF). Circ Heart Fail. 2014;7(1):51–8.

    Article  CAS  Google Scholar 

  33. Clark H, Krum H, Hopper I. Worsening renal function during renin-angiotensin-aldosterone system inhibitor initiation and long-term outcomes in patients with left ventricular systolic dysfunction. Eur J Heart Fail. 2014;16(1879-0844; 1388-9842; 1):41–8.

    Article  CAS  Google Scholar 

  34. Damman K, Gori M, Claggett B, Jhund PS, Senni M, Lefkowitz MP, et al. Renal effects and associated outcomes during angiotensin-neprilysin inhibition in heart failure. JACC Heart Fail. 2018;6(6):489–98.

    Article  Google Scholar 

  35. Boerrigter G, Costello-Boerrigter LC, Abraham WT, Sutton MG, Heublein DM, Kruger KM, et al. Cardiac resynchronization therapy improves renal function in human heart failure with reduced glomerular filtration rate. J Card Fail. 2008;14(1532-8414; 7):539–46.

    Article  Google Scholar 

  36. Brisco MA, Kimmel SE, Coca SG, Putt ME, Jessup M, Tang WW, et al. Prevalence and prognostic importance of changes in renal function after mechanical circulatory support. Circ Heart Fail. 2014;7(1):68–75.

    Article  Google Scholar 

  37. Hasin T, Topilsky Y, Schirger JA, Li Z, Zhao Y, Boilson BA, et al. Changes in renal function after implantation of continuous-flow left ventricular assist devices. J Am Coll Cardiol. 2012;59(1):26–36.

    Article  Google Scholar 

  38. Pitt B, Segal R, Martinez FA, Meurers G, Cowley AJ, Thomas I, et al. Randomised trial of losartan versus captopril in patients over 65 with heart failure (Evaluation of Losartan in the Elderly Study, ELITE). Lancet. 1997;349(9054):747–52.

    Article  CAS  Google Scholar 

  39. Pitt B, Poole-Wilson PA, Segal R, Martinez FA, Dickstein K, Camm AJ, et al. Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial – the Losartan Heart Failure Survival Study ELITE II. Lancet. 2000;355(9215):1582–7.

    Article  CAS  Google Scholar 

  40. Damman K, Kjekshus J, Wikstrand J, Cleland JG, Komajda M, Wedel H, et al. Loop diuretics, renal function and clinical outcome in patients with heart failure and reduced ejection fraction. Eur J Heart Fail. 2016;18(3):328–36.

    Article  Google Scholar 

  41. Domanski M, Norman J, Pitt B, Haigney M, Hanlon S, Peyster E. Diuretic use, progressive heart failure, and death in patients in the Studies Of Left Ventricular Dysfunction (SOLVD). J Am Coll Cardiol. 2003;42(0735-1097; 0735-1097; 4):705–8.

    Article  CAS  Google Scholar 

  42. Ellison DH, Felker GM. Diuretic treatment in heart failure. N Engl J Med. 2017;377(20):1964–75.

    Article  CAS  Google Scholar 

  43. de Silva R, Nikitin NP, Witte KK, Rigby AS, Loh H, Nicholson A, et al. Effects of applying a standardised management algorithm for moderate to severe renal dysfunction in patients with chronic stable heart failure. Eur J Heart Fail. 2007;9(4):415–23.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands

    Kevin Damman

Authors
  1. Kevin Damman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kevin Damman .

Editor information

Editors and Affiliations

  1. Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA

    W. H. Wilson Tang

  2. Department of Internal Medicine, UZ Leuven, Leuven, Belgium

    Frederik H. Verbrugge

  3. Ziekenhuis Oost-Limburg, Genk University Hasselt, Genk, Belgium

    Wilfried Mullens

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Damman, K. (2020). A Patient with Progressive Renal Insufficiency in Chronic Heart Failure with Reduced Ejection Fraction. In: Tang, W., Verbrugge, F., Mullens, W. (eds) Cardiorenal Syndrome in Heart Failure. Springer, Cham. https://doi.org/10.1007/978-3-030-21033-5_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-21033-5_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-21032-8

  • Online ISBN: 978-3-030-21033-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation