aldosterone receptor antagonists in chronic heart failure with reduced ejection fraction in people with chronic kidney disease (CKD)

Last edited 10/2018 and last reviewed 10/2023

Treating chronic heart failure with reduced ejection fraction in people with chronic kidney disease

If eGFR 30-60 ml/min/1.73m2

• if eGFR > 45 ml/min/1,73m2 and < 60 ml/min/1,73m2
  • there is no indication to change doses or titration of suggested therapies indicated for chronic heart failure
    • first line treatments
      • ACEI (or ARB)
      • beta blocker
      • mineralocorticoid receptor antagonist
    • specialist initiated treatments
      • ivabradine
      • sacubutril valsartan
      • digoxin
      • hydralazine and nitrate combination
        
        
• if the person's eGFR is 45 ml/min/1.73m2 or below, consider lower doses and/or slower titration of dose of ACE inhibitors or ARBs, mineralocorticoid receptor antagonists and digoxin
  
  
• if eGFR below 30ml/min/1.73m2
  • specialist heart failure MDT should consider liaising with a renal physician

Notes:

• monitor the response to titration of medicines closely in people who have heart failure with reduced ejection fraction and chronic kidney disease, taking into account the increased risk of hyperkalaemia.

Reference:

• NICE (September 2018).Chronic heart failure in adults: diagnosis and management