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 μmol/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 μmol/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 μmol/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.