Curr Probl Cardiol. 2021 Nov 13:101047. doi: 10.1016/j.cpcardiol.2021.101047. Online ahead of print.
ABSTRACT
INTRODUCTION: Patients with advanced chronic kidney disease (CKD) have largely been excluded from randomized control trials (RCTs) in heart failure (HF). This creates a paucity of high quality evidence for guideline directed medical therapy (GDMT), particularly in patients with heart failure with reduced ejection fraction (HFrEF) and CKD.
METHODS: This is a systematic review looking at the patterns and rates of inclusion of CKD in RCTs among patients with HFrEF. The search included RCTs from January 2010 to December 2020. A heat map was constructed to reflect the stages of CKD stages. The percentage of studies that included advanced CKD (stages 4 to 5) was recorded and log transformed, and then fitted into a time regression model. A p value of <0.05 was considered statistically significant.
RESULTS: Out of the 3052 screened, 706 studies were included in the analysis. Only 61% of the RCTs reported at least some information on kidney function. There was a trend of increase in percentage of studies that included CKD stages 4 to 5 from years 2010 to 2020. This was confirmed with a statistically significant linear trend p=0.02 while the percentage of studies that included dialysis and kidney transplant recipients remained consistently low.
CONCLUSION: There is a paucity of high-quality evidence for GDMT in the HFrEF population with CKD, particularly in those with advanced non-dialytic CKD, those on maintenance dialysis and kidney transplant recipients. There is a pressing need for wider inclusion of patients with advanced CKD in RCTs of GDMT in HFrEF.
PMID:34785259 | DOI:10.1016/j.cpcardiol.2021.101047
