Effects of applying a standardised management algorithm for moderate to severe renal dysfunction in patients with chronic stable heart failure

Background: No specific guidelines exist on how to manage renal dysfunction (RD) in patients with chronic heart failure (CHF). Aims: To identify the proportion of patients with moderate to severe RD and CHF who showed an improvement in their renal function in response to a systematic management algorithm. Methods: Stable patients with CHF and RD (defined by a serum creatinine (SCr) of > 130 mu mol/l (> 1.5 mg/dl)) were enrolled into a systematic management algorithm. The following changes were implemented: switching aspirin to clopidogrel, halving the dose of both diuretics and angiotensin converting enzyme (ACE) inhibitors and switching between bisoprolol and carvedilol. Results: Two thirds of patients in whom diuretics were reduced, and one fifth of patients in whom ACE inhibitors were reduced, improved their SCr by >25.5 mu mol/l (0.3 mg/dl). All these changes were more marked in the presence of bilateral renal artery stenosis. Compared to a reference group, in whom no changes were implemented, the treatment group showed an improvement in their mean SCr by 35 mu mol/l (0.4 mg/dl), p<0.001. Conclusion: Manipulation of pharmacological therapy for patients with CHF and RD results in a substantial recovery of renal function in a minority of patients. (c) 2006 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.