Management of Heart Failure With Reduced Ejection Fraction in Patients With Diabetes Mellitus and Chronic Kidney Disease

Oct 23, 2023Seminars in nephrology

Managing Weak Heart Function in Patients With Diabetes and Kidney Disease

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Abstract

Heart failure, diabetes, and chronic kidney disease often coexist and worsen each other's prognosis.

β-blockers and other heart failure treatments may reduce mortality in patients with heart failure and reduced ejection fraction.
Uptake of these treatments in clinical practice remains low among patients with multiple comorbidities, including diabetes and chronic kidney disease.
Managing heart failure in patients with diabetes and chronic kidney disease can be particularly challenging due to their age and frailty.
Guideline-directed medical therapy for heart failure may have both acute and chronic effects on renal function in these patients.
Available evidence for foundational heart failure therapies in patients with diabetes and chronic kidney disease is discussed, highlighting current challenges.

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Heart failure (HF), diabetes, and chronic kidney disease (CKD) frequently coexist, with one comorbidity worsening the prognosis of another. β-blockers, angiotensin-receptor-neprilysin inhibitors, renin-angiotensin-aldosterone system inhibitors, mineralocorticoid-receptor antagonists, and sodium-glucose cotransporter-2 inhibitors all have been shown to reduce mortality in patients with HF with reduced ejection fraction. However, their uptake in real-world clinical practice remains low, especially among patients who have multiple other comorbidities such as CKD and diabetes. The management of HF in patients with diabetes and CKD can be especially challenging because these patients typically are older, frail, and have multiple other comorbidities, and guideline-directed medical therapy used in HF potentially can affect renal function acutely and chronically. In this article, we discuss the available evidence for each of the foundational HF therapies in patients with diabetes and CKD, emphasizing the current challenges and outlining future directions to optimize the management of HF among these high-risk patients.

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Management of Heart Failure With Reduced Ejection Fraction in Patients With Diabetes Mellitus and Chronic Kidney Disease

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