Effects of applying a standardised management algorithm for moderate to severe renal dysfunction in patients with chronic stable heart failure

doi:10.1016/j.ejheart.2006.10.003

European Journal of Heart Failure 2007 9(4):415-423; doi:10.1016/j.ejheart.2006.10.003

This Article

	Full Text
	FREE Full Text (PDF)
	Alert me when this article is cited
	Alert me if a correction is posted

Services

	Email this article to a friend
	Similar articles in this journal
	Similar articles in ISI Web of Science
	Similar articles in PubMed
	Alert me to new issues of the journal
	Add to My Personal Archive
	Download to citation manager
	Search for citing articles in: ISI Web of Science (2)
	Request Permissions
	Disclaimer

Google Scholar

	Articles by de Silva, R.
	Articles by Cleland, J. G.F.
	Search for Related Content

PubMed

	PubMed Citation
	Articles by de Silva, R.
	Articles by Cleland, J. G.F.

Social Bookmarking

	What's this?

Effects of applying a standardised management algorithm for moderate to severe renal dysfunction in patients with chronic stable heart failure

Ramesh de Silva^a^,*, Nikolay P. Nikitin^a, Klaus K.A. Witte^a, Alan S. Rigby^a, Huan Loh^a, Anthony Nicholson^b, Sunil Bhandari^c, Andrew L. Clark^a and John G.F. Cleland^a

^a Department of Cardiology, University of Hull, Castle Hill Hospital Kingston upon Hull, East Yorkshire, HU16 5JQ, United Kingdom
^b Department of Vascular Radiology, Leeds General Infirmary Leeds, West Yorkshire, LS1 3EX, United Kingdom
^c Department of Nephrology, Hull Royal Infirmary Kingston upon Hull, East Yorkshire, HU3 2JZ, United Kingdom

^* Corresponding author. Tel.: +44 1482 624073, +44 7931 581 623(Mobile); fax: +44 1482 624085. E-mail address: ramesh{at}desilva84.freeserve.co.uk

Abstract

Background: No specific guidelines exist on how to manage renal dysfunction(RD) in patients with chronic heart failure (CHF).

Aims: To identify the proportion of patients with moderate to severeRD and CHF who showed an improvement in their renal functionin response to a systematic management algorithm.

Methods: Stable patients with CHF and RD (defined by a serum creatinine(SCr) of >130 µmol/l (>1.5 mg/dl)) were enrolledinto a systematic management algorithm. The following changeswere implemented: switching aspirin to clopidogrel, halvingthe dose of both diuretics and angiotensin converting enzyme(ACE) inhibitors and switching between bisoprolol and carvedilol.

Results: Two thirds of patients in whom diuretics were reduced, and onefifth of patients in whom ACE inhibitors were reduced, improvedtheir SCr by >25.5 µmol/l (0.3 mg/dl). All these changeswere more marked in the presence of bilateral renal artery stenosis.Compared to a reference group, in whom no changes were implemented,the treatment group showed an improvement in their mean SCrby 35 µmol/l (0.4 mg/dl), p<0.001.

Conclusion: Manipulation of pharmacological therapy for patients with CHFand RD results in a substantial recovery of renal function ina minority of patients.

Key Words: Chronic heart failure • Renal dysfunction • Renal artery stenosis

Received April 22, 2006; Revised August 2, 2006; Accepted October 4, 2006

Add to CiteULike CiteULike Add to Connotea Connotea Add to Del.icio.us Del.icio.us What's this?

This article has been cited by other articles:

Y. Amsalem, M. Garty, R. Schwartz, A. Sandach, S. Behar, A. Caspi, S. Gottlieb, D. Ezra, B. S. Lewis, and J. Leor
Prevalence and significance of unrecognized renal insufficiency in patients with heart failure
Eur. Heart J., April 2, 2008; 29(8): 1029 - 1036.
[Abstract] [Full Text] [PDF]