Treatment of Chronic Heart Failure in Advanced Chronic Kidney Disease: The HAKA Multicenter Retrospective Real-World Study

Abstract

Plain Language SummaryPatients with advanced chronic kidney disease (aCKD) and heart failure (HF) are at high risk of poor outcomes including premature death and hospitalization. However, evidence on their management is scarce. Many pivotal clinical trials testing HF treatments have excluded patients with aCKD and there is a paucity of real-world data on the diagnosis and treatment of these patients. The cross-sectional and retrospective HAKA study has some novel findings. On the one hand, the large range in the prevalence of HF between centers suggests an underdiagnosed of HF in patients with aCKD cared for in some specialized aCKD units. On the other hand, foundational HF medications are markedly underprescribed in patients with HFrEF. The HAKA study results justify a call to action for clinicians to optimize the diagnosis and treatment of HF in patients with aCKD. In addition, they support that appropriate evidence-based pharmacological treatment of HF in patients with aCKD is an unmet medical need that urgently requires specific clinical trials.