Pharmacotherapy for Heart Failure in Patients with Renal Insufficiency
- Michael G. Shlipak, MD, MPH
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From the Veterans Affairs Medical Center and University of California, San Francisco, San Francisco, California.
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Figure. Renal function should be categorized by estimated glomerular filtration rate ( ), which can be calculated from the
serum creatinine level. Evidence supporting a beneficial effect on clinical outcomes from each medication within subgroups
of renal function is evaluated as definite, possible, or unknown by the author. These definitions are based on the range of
renal function represented within the clinical trials and the reporting of results specific to patients with renal insufficiency.
ACE = angiotensin-converting enzyme; ARB = angiotensin-receptor blocker. *Using Cockcroft–Gault equation or Modification of
Diet in Renal Disease formula . †Careful monitoring of renal function and electrolytes. ‡Possibly harmful because of hyperkalemia
risk. §Consider withholding therapy during states of volume depletion because of hyperkalemia risk. ‖Shown to help reduce
hospitalization but not mortality. Treatment algorithm for patients with systolic heart failure, based on renal function.GFR(6)(7)
- Copyright ©2004 by the American College of Physicians
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Ann Intern Med
June 3, 2003
vol. 138
no. 11
917-924
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