| Title: |
Practical management of worsening renal function in outpatients with heart failure and reduced ejection fraction: Statement from a panel of multidisciplinary experts and the Heart Failure Working Group of the French Society of Cardiology ; Prise en charge pratique de l’aggravation de fonction rénale chez les patients ambulatoires atteints d’insuffisance cardiaque à fraction d’éjection altérée: position d’un groupe multidisciplinaire d’experts et du Groupe Insuffisance Cardiaque et Cardiomyopathie (GICC) de la Société Française de Cardiologie |
| Authors: |
Mewton, Nathan; Girerd, Nicolas; Boffa, Jean-Jacques; Courivaud, Cécile; Isnard, Richard; Juillard, Laurent; Lamblin, Nicolas; Legrand, Matthieu; Logeart, Damien; Mariat, Christophe; Meune, Edith; Sabouret, Pierre; Sebbag, Laurent; Rossignol, Patrick |
| Contributors: |
EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacologie Clinique, Hospices Civils de Lyon, 69677 Bron, France; parent; Centre d'investigation clinique plurithématique Pierre Drouin Nancy (CIC-P); Centre d'investigation clinique Nancy (CIC); Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL); Défaillance Cardiovasculaire Aiguë et Chronique (DCAC); Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL); Cardiovascular and Renal Clinical Trialists Vandoeuvre-les-Nancy (INI-CRCT); Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu Nancy; French-Clinical Research Infrastructure Network - F-CRIN Paris (Cardiovascular & Renal Clinical Trialists - CRCT); CHU Tenon AP-HP; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU); Des Maladies Rénales Rares aux Maladies Fréquentes, Remodelage et Réparation; Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU); Service de Néphrologie CHRU Besançon; Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon); Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN); Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition CHU Pitié Salpêtrière (IHU ICAN); CHU Pitié-Salpêtrière AP-HP; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière AP-HP; Service de Néphrologie Lyon; Hospices Civils de Lyon (HCL)-Centre Hospitalier Lyon Sud CHU - HCL (CHLS); Hospices Civils de Lyon (HCL); Epidémiologie des maladies chroniques : impact des interactions gène environnement sur la santé des populations; Institut Pasteur de Lille; Pasteur Network (Réseau International des Instituts Pasteur)-Pasteur Network (Réseau International des Instituts Pasteur)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé; Pole Cardio-vasculaire et pulmonaire CHU Lille; Centre Hospitalier Régional Universitaire CHU Lille (CHRU Lille); Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)); Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal Paris; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord; University of California San Francisco (UC San Francisco); University of California (UC); Hôpital Lariboisière-Fernand-Widal APHP; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP); Service de Néphrologie Dialyse, Transplantation rénale CHU Saint Etienne; Centre Hospitalier Universitaire de Saint-Etienne CHU Saint-Etienne (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM); Université Jean Monnet - Saint-Étienne (UJM); Hôpital Max Fourestier, Nanterre; Institut de cardiologie CHU Pitié-Salpêtrière; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU) |
| Source: |
ISSN: 1875-2136. |
| Publisher Information: |
CCSD; Elsevier; Société française de cardiologie [2008-.] |
| Publication Year: |
2020 |
| Collection: |
Université Jean Monnet – Saint-Etienne: HAL |
| Subject Terms: |
Cardiac edema; Cardiovascular disease; Cardiorenal syndrome; Insuffisance cardiaque; Heart failure; Chronic kidney disease; Syndrome cardio-rénal; Renal function; Systolic; Fonction rénale; Hyperkalemia; Hyperkaliémie; Maladie cardiovasculaire; Maladie rénale chronique; Œdèmes d’origine cardiaque; systolique; [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system; [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology |
| Description: |
International audience ; Renal function is often affected in patients with chronic heart failure with reduced ejection fraction (HFrEF). The complex interplay between heart and renal dysfunction makes renal function and potassium monitoring mandatory. Renin-angiotensin-aldosterone system (RAAS) blockers are a life-saving treatment for patients with HFrEF, regardless of worsening renal function. Uptitration to the maximum-tolerated dose should be a constant goal. This simple fact is all too often forgotten (only 30% of patients with heart failure receive the target dosage of RAAS blockers), and the RAAS blocker effect on renal function is sometimes misunderstood. RAAS blockers are not nephrotoxic drugs as they only have a functional effect on renal function. In many routine clinical cases, RAAS blockers are withheld or stopped because of this misunderstanding, combined with suboptimal assessment of the clinical situation and underestimation of the life-saving effect of RAAS blockers despite worsening renal function. In this expert panel, which includes heart failure specialists, geriatricians and nephrologists, we propose therapeutic management algorithms for worsening renal function for physicians in charge of outpatients with chronic heart failure. Firstly, the essential variables to take into consideration before changing treatment are the presence of concomitant disorders that could alter renal function status (e.g. infection, diarrhoea, hyperthermia), congestion/dehydration status, blood pressure and intake of nephrotoxic drugs. Secondly, physicians are invited to adapt medication according to four clinical scenarios (patient with congestion, dehydration, hypotension or hyperkalaemia). Close biological monitoring after treatment modification is mandatory. We believe that this practical clinically minded management algorithm can help to optimize HFrEF treatment in routine clinical practice. ; La fonction rénale des patients insuffisants cardiaques avec fraction d’éjection réduite (IC-rFE) est fréquemment ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/32660835; PUBMED: 32660835 |
| DOI: |
10.1016/j.acvd.2020.03.018 |
| Availability: |
https://hal.science/hal-02902558; https://hal.science/hal-02902558v1/document; https://hal.science/hal-02902558v1/file/WRF%20and%20RASI%20in%20CHF%20outpatients.pdf; https://doi.org/10.1016/j.acvd.2020.03.018 |
| Rights: |
http://creativecommons.org/licenses/by-nc-nd/ ; info:eu-repo/semantics/OpenAccess |
| Accession Number: |
edsbas.B5D54827 |
| Database: |
BASE |