Representation of Chronic Kidney Disease in Randomized Controlled Trials Among Patients With Heart failure With Reduced Ejection Fraction: A Systematic Review

•There is paucity of high-quality evidence for guideline directed medical therapy in the heart failure with reduced ejection fraction (HFrEF) population with chronic kidney disease.•Dialysis and kidney transplant recipients are underrepresented in HFrEF trials.•There is a need for wider inclusion of patients with advanced chronic kidney disease in randomized control trials in HFrEF. Patients with advanced chronic kidney disease (CKD) have largely been excluded from randomized control trials (RCTs) in heart failure (HF). This creates a paucity of high quality evidence for guideline directed medical therapy (GDMT), particularly in patients with heart failure with reduced ejection fraction (HFrEF) and CKD. This is a systematic review looking at the patterns and rates of inclusion of CKD in RCTs among patients with HFrEF. The search included RCTs from January 2010 to December 2020. A heat map was constructed to reflect the stages of CKD stages. The percentage of studies that included advanced CKD (stages IV-V) was recorded and log transformed, and then fitted into a time regression model. A P value of