Renin-angiotensin system inhibitors for patients with mild or moderate chronic kidney disease and heart failure with mildly reduced or preserved ejection fraction

• Published in: International journal of cardiology Vol. 409; p. 132190
• Main Authors: Takeuchi, Shinsuke, Kohno, Takashi, Goda, Ayumi, Shiraishi, Yasuyuki, Kitamura, Mitsunobu, Nagatomo, Yuji, Takei, Makoto, Nomoto, Michiru, Soejima, Kyoko, Kohsaka, Shun, Yoshikawa, Tsutomu
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.08.2024
• Subjects: Chronic kidney disease; Heart failure; Preserved ejection fraction; Renin-angiotensin system; Heart failure; eGFR; NYHA; OR; RASI; BNP; CI; LVEF; Chronic kidney disease; HR; HFpEF; Renin-angiotensin system; HFrEF; WET-HF; HFmrEF; ARB; Preserved ejection fraction; ACEI; SHR; CKD; MRA; HF
• ISSN: 0167-5273; 1874-1754; 1874-1754
• DOI: 10.1016/j.ijcard.2024.132190

Renin-angiotensin system inhibitors (RASI) reduce adverse cardiovascular events in patients with heart failure (HF) with left ventricular ejection fraction (LVEF) ≤40% and mild or moderate chronic kidney disease (CKD). However, RASI administration rate and its association with long-term outcomes in patients with CKD complicated by HF with LVEF >40% remain unclear. We analyzed 1923 consecutive patients with LVEF >40% registered within the multicenter database for hospitalized HF. We assessed RASI administration rate and its association with all-cause mortality among patients with mild or moderate CKD (estimated glomerular filtration rate [eGFR]: 30–60 mL/min/1.73 m2). Exploratory subgroups included patients grouped by age (<80, ≥80 years), sex, previous HF hospitalization, B-type natriuretic peptide (higher, lower than median), eGFR (30–44, 45–59 mL/min/1.73 m2), systolic blood pressure (<120, ≥120 mmHg), LVEF (41–49, ≥50%), and mineralocorticoid receptor antagonists (MRA) use. Among patients with LVEF >40%, 980 (51.0%) had mild or moderate CKD (age: 81 [74–86] years; male, 52.6%; hypertension, 69.7%; diabetes, 25.9%), and 370 (37.8%) did not receive RASI. RASI use was associated with hypertension, absence of atrial fibrillation, and MRA use. After multivariable adjustments, RASI use was independently associated with lower all-cause mortality over a 2-year median follow-up (hazard ratio: 0.58, 95% confidence interval: 0.43–0.79, P = 0.001), and the mortality rate difference was predominantly due to cardiac death, consistent in all subgroups. Approximately one-third of HF patients with mild or moderate CKD and LVEF >40% were discharged without RASI administration and demonstrated relatively guarded outcomes. •CKD is one of the most important comorbidities in HF patients with preserved EF.•In mild or moderate CKD, the cardiovascular benefits of RASI are demonstrated.•Non-use of RASI was common in HF patients with mild or moderate CKD and LVEF >40%.•RASI use was associated with hypertension, absence of atrial fibrillation, and MRA use in mild/moderate CKD.•RASI use was associated with lower all-cause death and cardiac-related death.