The MRA finerenone has been shown to slow kidney disease progression and reduce heart failure hospitalizations in patients with proteinuric diabetic kidney disease without heart failure with reduced ejection fraction (HFrEF) and NYHA II-IV. The steroidal MRAs are strongly recommended in HFrEF(1a) and recommended by the US guidelines in HFpEF and HFrEf (2b). SGLT2 inhibitors have also been shown to have consistent beneficial effects across stages of CKD outside of the severity of heart failure, independent of the ejection fraction.
A strong body of evidence suggests that beta-blockers improve prognosis in patients with concomitant CKD stage 1-3 and heart failure and reduced ejection fraction. Specifically, studies on bisoprolol, carvedilol, and metoprolol have been associated with improved prognosis in patients with heart failure and concomitant CKD.
Both angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers may lead to a decrease in estimated glomerular filtration in patients with heart failure; however, the benefit of angiotensin blockade in terms of prognosis in patients with heart failure and reduced left ventricular ejection fraction appears to be sustained.
Learn more about managing cardiovascular risk in patients with CKD.
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Cite this: Patrick Rossignol. Fast Five Quiz: Chronic Kidney Disease and Heart Failure - Medscape - Feb 03, 2023.