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    What to do with foundation therapies for heart failure for patients with end-stage kidney disease on haemodialysis

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    Author
    Adenwalla, Sherna
    Graham-Brown, Matthew
    Hull, Katherine
    Keyword
    Dialysis
    End-stage kidney disease
    Foundation therapies
    Heart failure
    Management
    Date
    2024-04-30
    
    Metadata
    Show full item record
    DOI
    10.12968/hmed.2023.0452
    Publisher's URL
    https://www.magonlinelibrary.com/doi/full/10.12968/hmed.2023.0452
    Abstract
    There is a significant burden of cardiovascular disease morbidity and mortality in the end-stage kidney disease population, driven by traditional and non-traditional risk factors. Despite its prevalence, heart failure is difficult to diagnose in the dialysis population due to overlapping clinical presentations, limitations of investigations, and the impact on the cardiorenal axis. 'Foundation therapies' are the key medications which improve patient outcomes in heart failure with reduced ejection fraction and include beta-blockers, renin-angiotensin-aldosterone system inhibitors and sodium-glucose cotransporter-2 inhibitors. They are underutilised in the dialysis population due to the exclusion of chronic kidney disease patients from major trials and legitimate clinical concerns e.g. hyperkalaemia, intradialytic hypotension and residual kidney function preservation. A coordinated cardiorenal multidisciplinary approach can guide appropriate diagnostic considerations (biomarkers interpretation, imaging, addressing unique complications of kidney disease), optimise dialysis management (prescription length, frequency and ultrafiltration targets) and when at euvolaemia facilitate the stepwise introduction of appropriate foundation therapies.
    Citation
    Adenwalla, S. F., Hull, K. L., & Graham-Brown, M. P. (2024). What to do with foundation therapies for heart failure for patients with end-stage kidney disease on haemodialysis. British journal of hospital medicine (London, England : 2005), 85(4), 1–10. https://doi.org/10.12968/hmed.2023.0452
    Type
    Article
    URI
    http://hdl.handle.net/20.500.12904/18593
    Collections
    Renal and Transplant

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