A randomized clinical trial to determine the effect of angiotensin inhibitors reduction on creatinine clearance and haemoglobin in heart failure patients with chronic kidney disease and anaemia
Summary Background Chronic kidney disease is a common comorbidity in elderly patients with heart failure. Evidence supports the use of angiotensin inhibitors for patients with heart failure. However, there is little evidence with which to assess the risk and benefits of this treatment in elderly pat...
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| Veröffentlicht in: | International journal of clinical practice (Esher) 2014-10, Vol.68 (10), p.1231-1238 |
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| container_title | International journal of clinical practice (Esher) |
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| creator | Pita-Fernández, S. Chouciño-Fernández, T. Juega-Puig, J. Seoane-Pillado, T. López-Calviño, B. Pértega-Díaz, S. Pedreira-Andrade, J.-D. Gil-Guillén, V. |
| description | Summary
Background
Chronic kidney disease is a common comorbidity in elderly patients with heart failure. Evidence supports the use of angiotensin inhibitors for patients with heart failure. However, there is little evidence with which to assess the risk and benefits of this treatment in elderly patients with renal dysfunction.
Objective
To determine the efficacy and safety of angiotensin inhibitor reduction in patients with heart failure, chronic kidney disease and anaemia.
Study design
Open randomized controlled clinical trial.
Setting
Complexo Hospitalario Universitario A Coruña (Spain).
Patients
Patients ≥ 50 years old, with heart failure, haemoglobin (Hb) |
| doi_str_mv | 10.1111/ijcp.12475 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1567050455</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3447985751</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4315-54d29e1379387cc050e83e171ae44141ff71bbe4816f3275041847ba9bc40b633</originalsourceid><addsrcrecordid>eNp9kd9uFCEUhydGY2v1xgcwJN4Yk6kwwDB72Wy0VquuiUbjDWGYM52znYEVmNT17Xwz2W7bCy8khD_h-30QTlE8ZfSY5fYK13ZzzCqh5L3ikClRlXnD7uc1r5tSUs4OikcxrimtpGzow-KgklRQJurD4s8JCcZ1fsLf0BE7okNrRpIC7kZPOkgQJnRA0gAE-h5sIr4nxl2gT-AiOoJuwBaTD5EE6Gab0DuSuw1gUhbmsB3B5Hss5GBHBgOTvxh9ex0mQz5LpDc4zgHIJmfApUiuMA3EDsHnJ5FL7BxsSYcRTNxbjMsaNI-LB70ZIzy5mY-Kr29ef1m-Lc8_nZ4tT85LKziTpRRdtQDG1YI3yloqKTQcmGIGhGCC9b1ibQuiYXXPK5U_iDVCtWbRWkHbmvOj4sXeuwn-5wwx6QmjhXE0DvwcNZO1ylYhZUaf_4Ou_Rxcft2OqmvGJaOZermnbPAxBuj1JuBkwlYzqneF1bvC6uvCZvjZjXJuJ-ju0NtKZoDtgSscYfsflT57t1zdSst9BmOCX3cZEy51rXhGv3081avv71cfPlOpf_C_ulHABQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1566613510</pqid></control><display><type>article</type><title>A randomized clinical trial to determine the effect of angiotensin inhibitors reduction on creatinine clearance and haemoglobin in heart failure patients with chronic kidney disease and anaemia</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Pita-Fernández, S. ; Chouciño-Fernández, T. ; Juega-Puig, J. ; Seoane-Pillado, T. ; López-Calviño, B. ; Pértega-Díaz, S. ; Pedreira-Andrade, J.-D. ; Gil-Guillén, V.</creator><creatorcontrib>Pita-Fernández, S. ; Chouciño-Fernández, T. ; Juega-Puig, J. ; Seoane-Pillado, T. ; López-Calviño, B. ; Pértega-Díaz, S. ; Pedreira-Andrade, J.-D. ; Gil-Guillén, V.</creatorcontrib><description>Summary
Background
Chronic kidney disease is a common comorbidity in elderly patients with heart failure. Evidence supports the use of angiotensin inhibitors for patients with heart failure. However, there is little evidence with which to assess the risk and benefits of this treatment in elderly patients with renal dysfunction.
Objective
To determine the efficacy and safety of angiotensin inhibitor reduction in patients with heart failure, chronic kidney disease and anaemia.
Study design
Open randomized controlled clinical trial.
Setting
Complexo Hospitalario Universitario A Coruña (Spain).
Patients
Patients ≥ 50 years old, with heart failure, haemoglobin (Hb) < 12 mg/dl and creatinine clearance <60 ml/min/1.73 m2 admitted to hospital, in treatment with angiotensin inhibitors. Informed consent and Ethical Review Board approval were obtained.
Intervention
A 50% reduction of angiotensin inhibitor dose of the basal treatment on admission (n = 30) in the intervention group. Control group (n = 16) with the standard basal dose.
Main outcome measure
Primary outcome was difference in Hb (gr/dl), creatinine clearance (ml/min/1.73 m2) and protein C (mg/dl) between admission and 1–3 months after discharge. Secondary outcome was survival at 6–12 months after discharge.
Results
Patients in the intervention group experienced an improvement in Hb (10.62–11.47 g/dl), creatinine clearance (32.5 ml/min/1.73 m2 to 42.9 ml/min/1.73 m2), and a decrease in creatinine levels (1.98–1.68 mg/dl) and protein C (3.23 mg/dl to 1.37 mg/dl). There were no significant differences in these variables in the control group. Survival at 6 and 12 months in the intervention and control group was 86.7% vs. 75% and 69.3% vs. 50%, respectively.
Conclusion
The reduction of the dose of angiotensin inhibitors in the intervention group resulted in an improvement in anaemia and kidney function, decreased protein C and an increased survival rate. Trial registration: EudraCT: 2008‐008480‐10.</description><identifier>ISSN: 1368-5031</identifier><identifier>EISSN: 1742-1241</identifier><identifier>DOI: 10.1111/ijcp.12475</identifier><identifier>PMID: 25040146</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>ACE inhibitors ; Anemia ; Anemia - complications ; Angiotensin Receptor Antagonists - administration & dosage ; Angiotensin Receptor Antagonists - adverse effects ; Angiotensin Receptor Antagonists - therapeutic use ; Clinical trials ; Creatinine - urine ; Female ; Heart failure ; Heart Failure - complications ; Heart Failure - drug therapy ; Hemoglobin ; Hemoglobins - deficiency ; Humans ; Kidney diseases ; Male ; Medical treatment ; Proteins ; Renal Insufficiency, Chronic - complications ; Spain</subject><ispartof>International journal of clinical practice (Esher), 2014-10, Vol.68 (10), p.1231-1238</ispartof><rights>2014 John Wiley & Sons Ltd</rights><rights>2014 John Wiley & Sons Ltd.</rights><rights>Copyright © 2014 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4315-54d29e1379387cc050e83e171ae44141ff71bbe4816f3275041847ba9bc40b633</citedby><cites>FETCH-LOGICAL-c4315-54d29e1379387cc050e83e171ae44141ff71bbe4816f3275041847ba9bc40b633</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fijcp.12475$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fijcp.12475$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25040146$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pita-Fernández, S.</creatorcontrib><creatorcontrib>Chouciño-Fernández, T.</creatorcontrib><creatorcontrib>Juega-Puig, J.</creatorcontrib><creatorcontrib>Seoane-Pillado, T.</creatorcontrib><creatorcontrib>López-Calviño, B.</creatorcontrib><creatorcontrib>Pértega-Díaz, S.</creatorcontrib><creatorcontrib>Pedreira-Andrade, J.-D.</creatorcontrib><creatorcontrib>Gil-Guillén, V.</creatorcontrib><title>A randomized clinical trial to determine the effect of angiotensin inhibitors reduction on creatinine clearance and haemoglobin in heart failure patients with chronic kidney disease and anaemia</title><title>International journal of clinical practice (Esher)</title><addtitle>Int J Clin Pract</addtitle><description>Summary
Background
Chronic kidney disease is a common comorbidity in elderly patients with heart failure. Evidence supports the use of angiotensin inhibitors for patients with heart failure. However, there is little evidence with which to assess the risk and benefits of this treatment in elderly patients with renal dysfunction.
Objective
To determine the efficacy and safety of angiotensin inhibitor reduction in patients with heart failure, chronic kidney disease and anaemia.
Study design
Open randomized controlled clinical trial.
Setting
Complexo Hospitalario Universitario A Coruña (Spain).
Patients
Patients ≥ 50 years old, with heart failure, haemoglobin (Hb) < 12 mg/dl and creatinine clearance <60 ml/min/1.73 m2 admitted to hospital, in treatment with angiotensin inhibitors. Informed consent and Ethical Review Board approval were obtained.
Intervention
A 50% reduction of angiotensin inhibitor dose of the basal treatment on admission (n = 30) in the intervention group. Control group (n = 16) with the standard basal dose.
Main outcome measure
Primary outcome was difference in Hb (gr/dl), creatinine clearance (ml/min/1.73 m2) and protein C (mg/dl) between admission and 1–3 months after discharge. Secondary outcome was survival at 6–12 months after discharge.
Results
Patients in the intervention group experienced an improvement in Hb (10.62–11.47 g/dl), creatinine clearance (32.5 ml/min/1.73 m2 to 42.9 ml/min/1.73 m2), and a decrease in creatinine levels (1.98–1.68 mg/dl) and protein C (3.23 mg/dl to 1.37 mg/dl). There were no significant differences in these variables in the control group. Survival at 6 and 12 months in the intervention and control group was 86.7% vs. 75% and 69.3% vs. 50%, respectively.
Conclusion
The reduction of the dose of angiotensin inhibitors in the intervention group resulted in an improvement in anaemia and kidney function, decreased protein C and an increased survival rate. Trial registration: EudraCT: 2008‐008480‐10.</description><subject>ACE inhibitors</subject><subject>Anemia</subject><subject>Anemia - complications</subject><subject>Angiotensin Receptor Antagonists - administration & dosage</subject><subject>Angiotensin Receptor Antagonists - adverse effects</subject><subject>Angiotensin Receptor Antagonists - therapeutic use</subject><subject>Clinical trials</subject><subject>Creatinine - urine</subject><subject>Female</subject><subject>Heart failure</subject><subject>Heart Failure - complications</subject><subject>Heart Failure - drug therapy</subject><subject>Hemoglobin</subject><subject>Hemoglobins - deficiency</subject><subject>Humans</subject><subject>Kidney diseases</subject><subject>Male</subject><subject>Medical treatment</subject><subject>Proteins</subject><subject>Renal Insufficiency, Chronic - complications</subject><subject>Spain</subject><issn>1368-5031</issn><issn>1742-1241</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kd9uFCEUhydGY2v1xgcwJN4Yk6kwwDB72Wy0VquuiUbjDWGYM52znYEVmNT17Xwz2W7bCy8khD_h-30QTlE8ZfSY5fYK13ZzzCqh5L3ikClRlXnD7uc1r5tSUs4OikcxrimtpGzow-KgklRQJurD4s8JCcZ1fsLf0BE7okNrRpIC7kZPOkgQJnRA0gAE-h5sIr4nxl2gT-AiOoJuwBaTD5EE6Gab0DuSuw1gUhbmsB3B5Hss5GBHBgOTvxh9ex0mQz5LpDc4zgHIJmfApUiuMA3EDsHnJ5FL7BxsSYcRTNxbjMsaNI-LB70ZIzy5mY-Kr29ef1m-Lc8_nZ4tT85LKziTpRRdtQDG1YI3yloqKTQcmGIGhGCC9b1ibQuiYXXPK5U_iDVCtWbRWkHbmvOj4sXeuwn-5wwx6QmjhXE0DvwcNZO1ylYhZUaf_4Ou_Rxcft2OqmvGJaOZermnbPAxBuj1JuBkwlYzqneF1bvC6uvCZvjZjXJuJ-ju0NtKZoDtgSscYfsflT57t1zdSst9BmOCX3cZEy51rXhGv3081avv71cfPlOpf_C_ulHABQ</recordid><startdate>201410</startdate><enddate>201410</enddate><creator>Pita-Fernández, S.</creator><creator>Chouciño-Fernández, T.</creator><creator>Juega-Puig, J.</creator><creator>Seoane-Pillado, T.</creator><creator>López-Calviño, B.</creator><creator>Pértega-Díaz, S.</creator><creator>Pedreira-Andrade, J.-D.</creator><creator>Gil-Guillén, V.</creator><general>Blackwell Publishing Ltd</general><general>Hindawi Limited</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T5</scope><scope>7TK</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>201410</creationdate><title>A randomized clinical trial to determine the effect of angiotensin inhibitors reduction on creatinine clearance and haemoglobin in heart failure patients with chronic kidney disease and anaemia</title><author>Pita-Fernández, S. ; Chouciño-Fernández, T. ; Juega-Puig, J. ; Seoane-Pillado, T. ; López-Calviño, B. ; Pértega-Díaz, S. ; Pedreira-Andrade, J.-D. ; Gil-Guillén, V.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4315-54d29e1379387cc050e83e171ae44141ff71bbe4816f3275041847ba9bc40b633</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>ACE inhibitors</topic><topic>Anemia</topic><topic>Anemia - complications</topic><topic>Angiotensin Receptor Antagonists - administration & dosage</topic><topic>Angiotensin Receptor Antagonists - adverse effects</topic><topic>Angiotensin Receptor Antagonists - therapeutic use</topic><topic>Clinical trials</topic><topic>Creatinine - urine</topic><topic>Female</topic><topic>Heart failure</topic><topic>Heart Failure - complications</topic><topic>Heart Failure - drug therapy</topic><topic>Hemoglobin</topic><topic>Hemoglobins - deficiency</topic><topic>Humans</topic><topic>Kidney diseases</topic><topic>Male</topic><topic>Medical treatment</topic><topic>Proteins</topic><topic>Renal Insufficiency, Chronic - complications</topic><topic>Spain</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pita-Fernández, S.</creatorcontrib><creatorcontrib>Chouciño-Fernández, T.</creatorcontrib><creatorcontrib>Juega-Puig, J.</creatorcontrib><creatorcontrib>Seoane-Pillado, T.</creatorcontrib><creatorcontrib>López-Calviño, B.</creatorcontrib><creatorcontrib>Pértega-Díaz, S.</creatorcontrib><creatorcontrib>Pedreira-Andrade, J.-D.</creatorcontrib><creatorcontrib>Gil-Guillén, V.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of clinical practice (Esher)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pita-Fernández, S.</au><au>Chouciño-Fernández, T.</au><au>Juega-Puig, J.</au><au>Seoane-Pillado, T.</au><au>López-Calviño, B.</au><au>Pértega-Díaz, S.</au><au>Pedreira-Andrade, J.-D.</au><au>Gil-Guillén, V.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A randomized clinical trial to determine the effect of angiotensin inhibitors reduction on creatinine clearance and haemoglobin in heart failure patients with chronic kidney disease and anaemia</atitle><jtitle>International journal of clinical practice (Esher)</jtitle><addtitle>Int J Clin Pract</addtitle><date>2014-10</date><risdate>2014</risdate><volume>68</volume><issue>10</issue><spage>1231</spage><epage>1238</epage><pages>1231-1238</pages><issn>1368-5031</issn><eissn>1742-1241</eissn><abstract>Summary
Background
Chronic kidney disease is a common comorbidity in elderly patients with heart failure. Evidence supports the use of angiotensin inhibitors for patients with heart failure. However, there is little evidence with which to assess the risk and benefits of this treatment in elderly patients with renal dysfunction.
Objective
To determine the efficacy and safety of angiotensin inhibitor reduction in patients with heart failure, chronic kidney disease and anaemia.
Study design
Open randomized controlled clinical trial.
Setting
Complexo Hospitalario Universitario A Coruña (Spain).
Patients
Patients ≥ 50 years old, with heart failure, haemoglobin (Hb) < 12 mg/dl and creatinine clearance <60 ml/min/1.73 m2 admitted to hospital, in treatment with angiotensin inhibitors. Informed consent and Ethical Review Board approval were obtained.
Intervention
A 50% reduction of angiotensin inhibitor dose of the basal treatment on admission (n = 30) in the intervention group. Control group (n = 16) with the standard basal dose.
Main outcome measure
Primary outcome was difference in Hb (gr/dl), creatinine clearance (ml/min/1.73 m2) and protein C (mg/dl) between admission and 1–3 months after discharge. Secondary outcome was survival at 6–12 months after discharge.
Results
Patients in the intervention group experienced an improvement in Hb (10.62–11.47 g/dl), creatinine clearance (32.5 ml/min/1.73 m2 to 42.9 ml/min/1.73 m2), and a decrease in creatinine levels (1.98–1.68 mg/dl) and protein C (3.23 mg/dl to 1.37 mg/dl). There were no significant differences in these variables in the control group. Survival at 6 and 12 months in the intervention and control group was 86.7% vs. 75% and 69.3% vs. 50%, respectively.
Conclusion
The reduction of the dose of angiotensin inhibitors in the intervention group resulted in an improvement in anaemia and kidney function, decreased protein C and an increased survival rate. Trial registration: EudraCT: 2008‐008480‐10.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>25040146</pmid><doi>10.1111/ijcp.12475</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1368-5031 |
| ispartof | International journal of clinical practice (Esher), 2014-10, Vol.68 (10), p.1231-1238 |
| issn | 1368-5031 1742-1241 |
| language | eng |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | ACE inhibitors Anemia Anemia - complications Angiotensin Receptor Antagonists - administration & dosage Angiotensin Receptor Antagonists - adverse effects Angiotensin Receptor Antagonists - therapeutic use Clinical trials Creatinine - urine Female Heart failure Heart Failure - complications Heart Failure - drug therapy Hemoglobin Hemoglobins - deficiency Humans Kidney diseases Male Medical treatment Proteins Renal Insufficiency, Chronic - complications Spain |
| title | A randomized clinical trial to determine the effect of angiotensin inhibitors reduction on creatinine clearance and haemoglobin in heart failure patients with chronic kidney disease and anaemia |
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