Management of heart failure in patients with end-stage kidney disease on maintenance dialysis: a practical guide
- 1 January 2020
- journal article
- review article
- Published by IMR Press in Reviews in Cardiovascular Medicine
- Vol. 21 (1), 31-39
- https://doi.org/10.31083/j.rcm.2020.01.24
Abstract
End-stage kidney disease (ESKD) and heart failure (HF) often coexist and must be managed simultaneously. Multidisciplinary collaboration between nephrology and cardiology is critical when treating patients with such complicated physiology. There is no "one-size-fits-all" approach to the evaluation of patients with new left ventricular systolic dysfunction, and diagnostic testing should be adapted to an individual's risk factors. Guideline-directed medical therapy (GDMT) for systolic heart failure should be employed in these patients. While limited randomized data exist, observational data and post hoc analyses suggest that GDMT, including renin angiotensin aldosterone system inhibitors, is associated with improved cardiovascular outcomes and can be safely initiated at low doses with close monitoring of kidney function in this population. Volume status is typically managed through ultrafiltration, so close communication between cardiology and nephrology is necessary to achieve a patient's optimal dry weight and mitigate intradialytic hypotension.Patient education and engagement regarding sodium and fluid restriction is crucial, and symptom burden should be reassessed following changes to the dialysis regimen.Keywords
This publication has 34 references indexed in Scilit:
- 2013 ACCF/AHA Guideline for the Management of Heart FailureJournal of the American College of Cardiology, 2013
- Coronary Vascular Dysfunction and Prognosis in Patients With Chronic Kidney DiseaseJACC: Cardiovascular Imaging, 2012
- Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO)Kidney International, 2011
- Assessment of cardiac ischaemia and viability: role of cardiovascular magnetic resonanceEuropean Heart Journal, 2011
- Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled studyThe Lancet, 2010
- Digoxin Associates with Mortality in ESRDJournal of the American Society of Nephrology, 2010
- Influence of Renal Function on the Use of Guideline-Recommended Therapies for Patients With Heart FailureThe American Journal of Cardiology, 2010
- Fluid Retention Is Associated With Cardiovascular Mortality in Patients Undergoing Long-Term HemodialysisCirculation, 2009
- Renal Function as a Predictor of Outcome in a Broad Spectrum of Patients With Heart FailureCirculation, 2006
- Carvedilol increases two-year survivalin dialysis patients with dilated cardiomyopathy: A prospective, placebo-controlled trialJournal of the American College of Cardiology, 2003