Representation of Chronic Kidney Disease in Randomized Controlled Trials Among Patients With Heart failure With Reduced Ejection Fraction: A Systematic Review

Kevin Bryan Lo, Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA. Electronic address: lokevinb@einstein.edu.
Hani Essa, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Liverpool Centre for Cardiovascular Science, Liverpool Heart & Chest Hospital, Liverpool, UK; University of Liverpool, Liverpool, UK.
Ammaar Wattoo, Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA.
Asma Gulab, Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA.
Hamza Akhtar, Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA.
Hussein Al Sudani, Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA.
Lucas Angelim, Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA.
Beth Helfman, Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA.
Eric Peterson, Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA.
Sophia Brousas, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
Isabel Whybrow-Huppatz, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
Ali Yazdanyar, Morsani College of Medicine, University of South Florida, Tampa, FL; Department of Medicine, Lincoln Medical Center, New York, NY.
Rajiv Sankaranarayanan, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Liverpool Centre for Cardiovascular Science, Liverpool Heart & Chest Hospital, Liverpool, UK; University of Liverpool, Liverpool, UK.
Janani Rangaswami, George Washington University School of Medicine, Washington, DC.

Document Type

Journal Article

Publication Date

3-1-2023

Journal

Current problems in cardiology

Volume

48

Issue

3

DOI

10.1016/j.cpcardiol.2021.101047

Abstract

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. 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 IV-V) was recorded and log transformed, and then fitted into a time regression model. A P value of <0.05 was considered statistically significant. 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 IV-V 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. 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.

Department

Medicine

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