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Does the presence of chronic kidney disease modify the advice of guidelines?

  • Impact on pharmacology of cardiovascular drugs, presented by L M Ruilope (Madrid, ES) - Slides
  • In hypertension, presented by E Ritz (Heidelberg, DE) - Slides 
  • In heart failure, presented by M R Cowie (London, GB) - Slides 
  • In acute coronary syndrome, presented by D Zahger (Beer Sheva, IL) - Slides 
Cardiovascular Pharmacology and Pharmacotherapy


The symposium was jointly organized by ESC and the European Renal Association.

The common origin of cardiovascular disease and CKD was reviewed. It was discussed how the treatment of one is equal to the treatment of the other, with the need to add specific therapy when renal function decrease is advanced. The risk of Renin-Angiotensin-Aldosterone-System suppression leading to a poorer treatment was emphasised. The importance of maintaining plasma-potassium in upper normal range was discussed.

The relationship between blood pressure (BP) and CKD, both in diabetic and non-diabetic patients was reviewed. Elevated BP particularly during the night correlates with an increased renal damage and more albuminuria, particularly in diabetics. The control of BP must contemplate duration of 24 hours. Patients in dialysis differ from those with CKD due to the fluctuations in volume and electrolytes interdialysis which is accompanied by a poor prognosis if excessive.

In heart failure, hypotension is a poor prognostic index in dialysis patients. An important conclusion was that in order to protect the kidney the earlier the therapy the better the outcome. Also, it should be noted that one level of BP does not fit with every CKD patient.

The relation between chronic heart failure and CKD was reviewed. It was demonstrated that the association is very frequent and complicates the therapy of these patients due to adverse effects of the drugs or a poor response to them. The Guidelines of ESC and ACC on patients with HF and CKD were found to be almost similar. Treatment in patients with advanced CKD is particularly difficult – e.g. in elderly hypotensive patients - and complicates the entrance into a dialysis program.

Acute coronary syndrome and CKD was reviewed. The association is frequent and it was pointed out that these patients are frequently undertreated for their coronary syndrome both pharmacologically and interventionally. Maybe, thrombolysis may be superior to Percoutaneous Coronary Intervention in CKD. In general, there were advocated for increased attention to heart patients with CKD in trials, in guidelines and in clinical practice.

References


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Does the presence of chronic kidney disease modify the advice of guidelines?

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.