aldosterone receptor antagonists in chronic heart failure with reduced ejection fraction in people with chronic kidney disease (CKD)

Last edited 10/2018 and last reviewed 10/2018

Treating chronic heart failure with reduced ejection fraction in people with chronic kidney disease

If eGFR 30-60 ml/min/1.73m2

  • if eGFR > 45 ml/min/1,73m2 and < 60 ml/min/1,73m2
    • there is no indication to change doses or titration of suggested therapies indicated for chronic heart failure
        • first line treatments
          • ACEI (or ARB)
          • beta blocker
          • mineralocorticoid receptor antagonist
        • specialist initiated treatments
          • ivabradine
          • sacubutril valsartan
          • digoxin
          • hydralazine and nitrate combination

  • if the person's eGFR is 45 ml/min/1.73m2 or below, consider lower doses and/or slower titration of dose of ACE inhibitors or ARBs, mineralocorticoid receptor antagonists and digoxin

  • if eGFR below 30ml/min/1.73m2
    • specialist heart failure MDT should consider liaising with a renal physician

Notes:

  • monitor the response to titration of medicines closely in people who have heart failure with reduced ejection fraction and chronic kidney disease, taking into account the increased risk of hyperkalaemia.

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