Blockade of renin-angiotensin-aldosterone system in patients with chronic heart failure and chronic kidney disease


DOI: https://dx.doi.org/10.18565/therapy.2023.3.121-128

Shutov A.M., Efremova E.V., Serov V.A.

Ulyanovsk State University
Abstract. Review contains the points of diagnosis and treatment of patients with chronic cardiorenal syndrome. Practical algorithms for the use of drugs blocking renin-angiotensin-aldosterone system (RAAS), aspects of safety and efficacy of therapy from the standpoint of cardio- and nephroprotection are discussed. The main problems of prescribing RAAS-blocking medicaments, which are arising during a therapeutic appointment in real clinical practice, are discussed.

Literature


1. Тареев Е.М. Нефриты. M.: Медизат (Медгиз/Государственное издательство медицинской литературы). 1958. [Tareev EM. Nephritis. Moscow Medizat (Medgiz/State Publishing House of Medical Literature).1958 (In Russ.)].


2. Dzau V. The cardiovascular continuum and renin-angiotensin-aldosterone system blockade. J Hypertens Suppl. 2005; 23(1): S9–17.


3. Dzau V.J., Antman E.M., Black H.R. et al. The cardiovascular disease continuum validated: clinical evidence of improved patient outcomes: part I: Pathophysiology and clinical trial evidence (risk factors through stable coronary artery disease). Circulation. 2006; 114(25) :2850–70. https://dx.doi.org/10.1161/CIRCULATIONAHA.106.655688.


4. Смирнов А.В., Добронравов В.А., Каюков И.Г. Кардио-ренальный континуум: Патогенетические основы превентивной нефрологии. Нефрология. 2005; 9(3): 7–15. [Smirnov AV, Dobronravov VA, Kayukov IG. Cardio-renal continuum: Pathogenetic foundations of preventive nephrology. Nefrologiya = Nephrology. 2005; 9(3): 7–15 (In Russ.)]. EDN: JUQJYL.


5. Ronco C., Haapio M., House A.A. et al. Cardiorenal syndrome. J Am Coll Cardiol. 2008; 52(19): 1527–39. https://dx.doi.org/10.1016/j.jacc.2008.07.051.


6. Cohen J.B., Schrauben S.J., Zhao L. et al. Clinical phenogroups in heart failure with preserved ejection fraction: Detailed phenotypes, prognosis and response to spironolactone. JACC Heart Fail. 2020; 8(3): 172–184. https://dx.doi.org/10.1016/j.jchf.2019.09.009.


7. Finamore P., Spruit M.A., Schols J.M.G.A. et al. Clustering of patients with end-stage chronic diseases by symptoms: A new approach to identify health needs. Aging clinical and experimental research. 2021; 33(2): 407–17. https://dx.doi.org/10.1007/s40520-020-01549-5.


8. Mullens W., Damman K., Testani J.M. et al. Evaluation of kidney function throughout the heart failure trajectory – A position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2020; 22(4): 584–603. https://dx.doi.org/10.1002/ejhf.1697.


9. Mullens W., Martens P., Testani J.M. et al. Renal effects of guideline-directed medical therapies in heart failure: a consensus document from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2022; 24(4): 603–19. https://dx.doi.org/10.1002/ejhf.2471.


10. United Nations General Assembly. Political declaration of the 3rd High-Level Meeting of the General Assembly on the Prevention and Control of Non-Communicable Diseases: Resolution adopted by the General Assembly. UN. General Assembly. High-Level Meeting of Heads of State and Government on the Prevention and Control of Non-Communicable Diseases. New York. 2018: 7.


11. Смирнов А.В., Шилов Е.М., Добронравов В.А. Национальные рекомендации. Хроническая болезнь почек: основные принципы скрининга, диагностики, профилактики и подходы к лечению. Нефрология. 2012; 16(1): 89–115. [Smirnov A.V., Shilov E.M., Dobronravov V.A. National recommendations. Chronic kidney disease: basic principles of screening, diagnosis, prevention and treatment approaches. Nefrologiya = Nephrology. 2012; 16(1): 89–115 (In Russ.)]. EDN: NJWAGE.


12. Клинические рекомендации. Хроническая болезнь почек. Ассоциация нефрологов. Рубрикатор клинических рекомендаций Минздрава России. 2021. ID: 469. Доступ: https://cr.minzdrav.gov.ru/schema/469_2 (дата обращения – 01.04.2023). [Clinical guidelines. Chronic kidney disease. Association of Nephrologists. Rubricator of clinical guidelines of the Ministry of Healthcare of Russia. 2021. ID: 469. URL: https://cr.minzdrav.gov.ru/schema/469_2 (date of access – 01.04.2023) (In Russ.)].


13. Johansen K.L., Chertow G.M., Gilbertson D.T. et al. United States Renal Data System 2022 annual data report: Epidemiology of kidney disease in the United States. Am J Kidney Dis. 2023; 81(3S1): A8–A11. https://dx.doi.org/10.1053/j.ajkd.2022.12.001.


14. Серов В.А., Шутов А.М. Кардиоренальные взаимоотношения при хронической сердечной недостаточности. Ульяновский государственный университет. 2011. [Serov V.A., Shutov A.M. Cardiorenal relationships in chronic heart failure. Ulyanovsk State University. 2011 (In Russ.)]. ISBN: 978-5-88866-417-9.


15. Ефремова Е.В., Шутов А.М. Прогностические биомаркеры при хроническом кардиоренальном синдроме у пациентов старшей возрастной группы. Нефрология и диализ. 2022; 24(2): 357–365. [Efremova E.V., Shutov A.M. Prognostic biomarkers in chronic cardiorenal syndrome in older patients. Nefrologiya i dializ = Nephrology and dialysis. 2022; 24(2): 357–365 (In Russ.)]. https://dx.doi.org/10.28996/2618-9801-2022-2-357-365. EDN: IHOSSU.


16. Levin A., Stevens P., Bilous R.W., Coresh J. Kidney Disease: Improving global outcomes (KDIGO) CKD work group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013; 3(1): 1–150. https://dx.doi.org/10.1038/kisup.2012.73.


17. Li P.K., Garcia-Garcia G., Lui S.F. et al. Kidney health for everyone everywhere – from prevention to detection and equitable access to care. Kidney Med. 2020; 2(1): 5–11. https://dx.doi.org/10.1016/j.xkme.2020.01.002.


18. Heras M., Garcia-Cosmes P., Fernandez-Reyes M., Sanchez R. Natural progression of renal function in the elderly: Analysis of poor prognosis factors associated with chronic kidney disease. Nefrologia. 2013; 33(4): 462–69. https://dx.doi.org/10.3265/Nefrologia.pre2013.Jan.11806.


19. Tangri N., Stevens L.A., Griffith J. et al. A predictive model for progression of chronic kidney disease to kidney failure. JAMA. 2011; 305(15): 1553–59. https://dx.doi.org/10.1001/jama.2011.451.


20. Ortiz A., Wanner C., Gansevoort R.; ERA Council. Chronic kidney disease as cardiovascular risk factor in routine clinical practice: A position statement by the Council of the European Renal Association. Eur J Prev Cardiol. 2022; 29(17): 2211–15. https://dx.doi.org/10.1093/eurjpc/zwac186.


21. Fink H.A., Ishani A., Taylor B.C. et al. Screening for, monitoring, and treatment of chronic kidney disease stages 1 to 3: A systematic review for the U.S. Preventive Services Task Force and for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2012; 156(8): 570–81. https://dx.doi.org/10.7326/0003-4819-156-8-201204170-00004.


22. Koncicki H.M., Swilder M.A. Decision making in elderly patients with advanced kidney disease. Clin Geriatr Med. 2013; 29(3): 641–55. https://dx.doi.org/10.1016/j.cger.2013.05.004.


23. Farrington K., Covic A., Nistor I. et al. Clinical practice guideline on management of older patients with chronic kidney disease stage 3b or higher (eGFR<45 mL/min/1.73 m2): A summary document from the European Renal Best Practice Group. Nephrol Dial Transplant. 2017; 32(1): 9–16. https://dx.doi.org/10.1093/ndt/gfw411.


24. Терещенко С.Н., Галявич А.С., Ускач Т.М. с соавт. Хроническая сердечная недостаточность. Клинические рекомендации 2020. Российский кардиологический журнал. 2020; 25(11): 311–374. [2020 Clinical practice guidelines for Chronic heart failure. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2020; 25(11): 2020; 25(11): 311–374 (In Russ.)]. https://dx.doi.org/10.15829/1560-4071-2020-4083. EDN: LJGGQV.


25. Ефремова Е.В., Шутов А.М., Подусов А.С. Биомаркеры миокардиальной и почечной дисфункции при хронической сердечной недостаточности. Нефрология и диализ. 2020; 22(2): 181–188. [Efremova E.V., Shutov A.M., Podusov A.S. Biomarkers of myocardial and renal dysfunction in chronic heart failure. Nefrologiya i dializ = Nephrology and dialysis. 2020; 22(2): 181–188 (In Russ.)]. https://dx.doi.org/10.28996/2618-9801-2020-2-181-188. EDN: RRPSPO.


26. Schaub J.A., Coca S.G., Moledina D.G. et al. Amino-terminal Pro-B-type natriuretic peptide for diagnosis and prognosis in patients with renal dysfunction: A systematic review and meta–analysis. JACC Heart failure. 2015; 3(12): 977–89. https://dx.doi.org/10.1016/j.jchf.2015.07.014.


27. Hajjar V., Schreiber M.J. Does measuring natriuretic peptides have a role in patients with chronic kidney disease? Cleve Clin J Med. 2009; 76(8): 476–78. https://dx.doi.org/10.3949/ccjm.76a.08065.


28. Park S., Cho G.Y., Kim S.G. et al. Brain natriuretic peptide levels have diagnostic and prognostic capability for cardio-renal syndrome type 4 in intensive care unit patients. Crit Care. 2009; 13(3): R70. https://dx.doi.org/10.1186/cc7878.


29. Ефремова Е.В., Шутов А.М., Макеева Е.Р. с соавт. Фактор, индуцируемый гипоксией-1 (HIF-1), как биомаркер острого повреждения почек у больных с острой декомпенсацией хронической сердечной недостаточности. Кардиология. 2019; 59(2S): 25–30. [Efremova E.V., Shutov A.M., Makeeva E.R. et al. Hypoxia-1 induced factor (HIF-1) as a biomarker of acute kidney injury in patients with acute decompensation of chronic heart failure. Kardiologiya = Cardiology. 2019; 59(2S): 25–30 (In Russ.)]. https://dx.doi.org/10.18087/cardio.2533. EDN: BYWLDH.


30. Руденко Т.Е., Кутырина И.М., Васильева М.П. Натрийуретические пептиды: диагностическое и прогностическое значения при хронической болезни почек. Клиническая нефрология. 2013; (2): 5–9. [Rudenko T.E., Kutyrina I.M., Vasilyeva M.P. Natriuretic peptides: Diagnostic and prognostic values in chronic kidney disease. Klinicheskaya nefrologiya = Clinical Nephrology. 2013; (2): 5–9 (In Russ.)]. EDN: QAWNRB.


31. McDonagh T.A., Metra M., Adamo M. et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021; 42(36): 3599–726. https://dx.doi.org/10.1093/eurheartj/ehab368.


32. Heidenreich P.A., Bozkurt B., Aguilar D. et al. 2022 AHA/ACC/HFSA guidelines for the management of heart failure: A report of the American College of Cardiology /American Heart Association joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022; 79(17): e263–e421. https://dx.doi.org/10.1016/j.jacc.2021.12.012.


33. Nagueh S., Smiseth O.A., Appleton C.P. et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016; 29(4): 277–314. https://dx.doi.org/10.1016/j.echo.2016.01.011.


34. Tong A., Manns B., Wang A.Y.M. et al. Implementing core outcomes in kidney disease: report of the Standardized Outcomes in Nephrology (SONG) implementation workshop. Kidney Int. 2018; 94(6): 1053–68. https://dx.doi.org/10.1016/j.kint.2018.08.018.


35. Hill L., Geller P.T., Baruah R. et al. Integration of a palliative approach into heart failure care: A European Society of Cardiology Heart Failure Association position paper. Eur J Heart Fail. 2020; 22(12): 2327–39. https://dx.doi.org/10.1002/ejhf.1994.


36. Kalantar-Zadeh K., Li P.K.T., Tantisattamo E. et al. World Kidney Day 2021: Living well with kidney disease by patient and care partner empowerment – Kidney health for everyone everywhere. Am J Kidney Dis. 2021; 77(4): 474–77. https://dx.doi.org/10.1053/j.ajkd.2021.01.001.


37. Клинические практические рекомендации KDIGO 2020 по тактике ведения диабета при хронической болезни почек. Нефрология и диализ. 2021; 23(S2): 9–121. [KDIGO 2020 clinical practice guidelines for diabetes management tactics in chronic kidney disease. Nefrologiya i dializ = Nephrology and dialysis. 2021; 23(S2): 9–121 (In Russ.)]. https://dx.doi.org/10.28996/2618-9801-2021-2suppl-9-121. EDN: BXRLIY.


38. Garg R., Yusuf S. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials. JAMA. 1995; 273(18): 1450–56.


39. Damman K., Gori M., Claggett B. et al. Renal effects and associated outcomes during angiotensin-neprilysin inhibition in heart failure. JACC Heart failure. 2018; 6(6): 489–98. https://dx.doi.org/10.1016/j.jchf.2018.02.004.


40. Guo Y., Ren M., Wang T. et al. Effects of sacubitril/valsartan in ESRD patients undergoing hemodialysis with HFpEF. Front Cardiovasc Med. 2022; 9: 955780. https://dx.doi.org/10.3389/fcvm.2022.955780.


41. Fu S., Xu Z., Lin B. et al. Effects of sacubitril-valsartan in heart failure with preserved ejection fraction in patients undergoing peritoneal dialysis. Front Med (Lausanne). 2021; 8: 657067. https://dx.doi.org/10.3389/fmed.2021.657067.


42. Bakris G.L., Agarwal R., Anker S.D. et al.; FIDELIO-DKD Investigators. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes. N Engl J Med. 2020; 383(23): 2219–29. https://dx.doi.org/10.1056/NEJMoa2025845


43. Перепеч Н.Б., Трегубов А.В., Михайлова И.Е. Оценка профессиональных знаний и приверженности врачей рекомендациям по диагностике и лечению больных хронической сердечной недостаточностью. Кардиология. 2022; 62(5): 53–61. [Perpech N.B., Tregubov A.V., Mikhailova I.E. Physicians’ adherence to the guidelines on the chronic heart failure diagnosis and treatment. Kardiologiya = Cardiology. 2022; 62(5): 53–61 (In Russ.)]. https://dx.doi.org/10.18087/cardio.2022.5.n1755. EDN: GNHWBA.


About the Autors


Alexander M. Shutov, MD, professor, head of the Department of therapy and occupational diseases of the medical faculty named after T.Z. Biktimirov of the Institute of medicine, ecology and physical education, Ulyanovsk State University. Address: 432017, Ulyanovsk, 42 Lva Tolstogo Str. E-mail: amshu@mail.ru.
ORCID: https://orcid.org/0000-0002-1213-8600
Elena Vladimirovna Efremova, MD, associate professor, professor of the Department of therapy and occupational diseases of the medical faculty named after T.Z. Biktimirov of the Institute of medicine, ecology and physical education, Ulyanovsk State University. Address: 432017, Ulyanovsk, 42 Lva Tolstogo Str. E-mail: lena_1953@mail.ru.
ORCID: https://orcid.org/0000-0002-7579-4824
Valeriy A. Serov, MD, associate professor, professor of the Department of therapy and occupational diseases of the medical faculty named after T.Z. Biktimirov of the Institute of medicine, ecology and physical education, Ulyanovsk State University. Address: 432017, Ulyanovsk, 42 Lva Tolstogo Str. E-mail: valery_serov@mail.ru. ORCID: https://orcid.org/0000-0003-1815-5599


Similar Articles


Бионика Медиа