100 Renal dysfunction and use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in chronic heart failure

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• 作者：Michel Galinier¹ ; Nacima Demil² ; Patrick Assyag³ ; Pascal De Groote⁴ ; Richard Isnard⁵ ; Guillaume Jondeau⁶ ; Alain Ducardonnet⁷ ; Jean-Fran&ccedil ; ois Thé ; baut⁸ ; Michel Komajda⁵
• 刊名：Archives of Cardiovascular Diseases Supplements
• 出版年：2010
• 出版时间：January 2010
• 年：2010
• 卷：2
• 期：1
• 页码：33
• 全文大小：78 K

文摘

Background

European Guidelines for the treatment of CHF 2008 underline that there is no absolute level of creatinine which precludes the use of angiotensin converting enzyme inhibitors (ACE-Is) or angiotensin receptor blocker (ARBs).

Aims

The IMPACT-RECO program III analysed the impact of NYHA class and of comorbidities on therapeutic management of French outpatients with stable CHF and low left ventricular ejection fraction (LVEF).

Methods

This survey was carried on 2007 among randomly selected French private cardiologists. 1574 patients with CHF and LVEF < 40 % were included.

Results

Mean age was 71 ¡À 11 years, 75 % of the patients were men, 34 % were in NYHA class III-IV, 54 % had coronary artery diseases, 30 % had atrial fibrillation and the mean LVEF was 34 ¡À 7 % . Creatinine value was recorded in 1332 patients. Mean creatinine concentration was 119 ¡À 50 ¦Ìmol/L and mean creatinine clearance was 59.6 ¡À 26.8 ml/kg/min. Renal dysfunction defined by creatinine concentration > 220 ¦Ìmol/L or 25 mg/dL was found in 173 patients. In the 467 patients not receiving ACEIs, reasons for non prescription were firstly contra-indication in 69 patients (14.8 % ) mostly because of renal dysfunction in 54 patients (78.3 % ), secondly side effects in 365 patients (78.2 % ) with renal insufficiency found in 25 patients (6.85 % ). In 1033 patients, ARBs was also not prescribed because of contra-indication for renal dysfunction in 79 patients (90.8 % ), or intolerance with renal insufficiency in 40 patients (32.8 % ). Thus, despite a mean creatinine clearance of 33.3 ¡À 15.1 mL/kg/min in 173 patients with renal dysfunction, ACEIs/ARB were not prescribed in 133 patients considering renal dysfunction as a contra-indication.

Conclusion

Renal dysfunction remains the main reason for not prescribing ACEIs/ARBs in CHF despite the possibility to easily adapt their dose to creatinine clearance. Improvement is still necessary so that ACEIs/ARBs should not be denied to CHF patients with concomitant renal dysfunction.