What is the evidence base for heart failure pharmacotherapies in people with severe chronic kidney disease?
The evidence base for heart failure pharmacotherapies in people with severe chronic kidney disease (eGFR<30 ml/min/1.73 m2) has been lacking, as these people have largely been excluded from key randomised controlled trials. In addition, the presence of even mild or moderate CKD (eGFR 31-59 ml/min/1.73 m2) can limit the ability to introduce and/or adequately up-titrate heart failure medications, many of which are potentially nephrotoxic and often reduced or discontinued in people with worsening renal function or acute kidney injury complicating intercurrent illness or concomitant drug therapy. The FAIR-HFpEF trial (https://clinicaltrials.gov/ct2/show/NCT03074591) will look at the outcomes exercise capacity, QoL, NYHA functional class, mortality and HF related hospitalisations in people with heart failure with preserved ejection fraction and iron deficiency with and without anaemia randomised to either IV iron or placebo.