Dr Julian Daniell1, Dr Sandra Crikis1, Associate Professor Craig Nelson1
1Western Health, , Australia
Biography:
I am a second year Nephrology advanced trainee, currently working at The Alfred Hospital in Melbourne, Victoria. I graduated from The University of Melbourne in 2017 and completed basic physician training at The Royal Melbourne Hospital in 2021. I am undertaking dual specialty training in Nephrology and General and Acute Care Medicine.
Aim:
To review current literature on the use of pharmacological treatment of heart failure with reduced ejection fraction (HFrEF) in the haemodialysis population and assess uptake in a large dialysis cohort.
Background:
HFrEF is common in patients requiring intermittent haemodialysis. The coexistence of these conditions exacerbates both, increasing morbidity and mortality. Although guideline-directed medical therapy (GDMT) for HFrEF is well established in the general population, evidence for dialysis patients is limited due to their exclusion from clinical trials. This study reviews the use of GDMT in a cohort of haemodialysis patients. Methods: An observational study was conducted in 2024 at Western Health, Melbourne, identifying patients receiving maintenance intermittent haemodialysis at satellite dialysis centres. Data were collected from electronic medical records, including diagnoses of HFrEF, transthoracic echocardiogram reports, prescribed medications, and cardiology involvement. Results: Of 233 patients identified, 212 had echocardiograms available. 33/212 (14.16%) had HFrEF. Among these, 75.76% had been reviewed by a cardiologist in the past 12 months, however only 63.64% were prescribed at least one GDMT, with beta-blockers the most common, followed by angiotensin II receptor blockers. Conclusion: Despite the finding of HFrEF a significant cohort were not on any GDMT. Not surprisingly Beta-blockers, were the most frequently prescribed medication, with the use of RAAS inhibitors and mineralocorticoid receptor antagonists low, likely due to concerns regarding hyperkalaemia and hypotension. This highlights a gap in the implementation of GDMT, despite its potential benefits. This review underscores the challenges in managing HFrEF in dialysis patients and the need for a more standardized approach to GDMT. Future research should focus on optimizing treatment strategies and dialysis parameters to improve patient outcomes in this complex population.