Pharmacotherapy for heart failure in patients with renal failure

Approximately 30-50% of patients with heart failure suffer from kidney failure (glomerular filtration rate (GFR) 22), and kidney failure is one of the strongest predictors of mortality in patients with heart failure. The article considers the pharmacotherapy of heart failure in patients with renal failure. It was concluded that the survival of patients with heart failure may increase with the use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), alpha- and beta-blockers, and spironolactone. ACE inhibitors and alpha and beta blockers are recommended as standard therapy for patients with heart failure and left ventricular dysfunction. Evidence supports the use of ACE inhibitors to improve survival in patients with moderate renal impairment (GFR 30 to 60 mL/min/1.73 m2). Spironolactone improves outcomes in patients with severe heart failure, but the presence of renal insufficiency increases the risk of hyperkalemia and limits the use of the drug in patients with severe renal insufficiency.