Renal function in patients with heart failure — a predictor for selecting RAAS inhibitors

Abstract

Over the last few years, there has been an increasing trend in the prevalence of chronic kidney diseases (CKD) in patients with chronic heart failure (CHF). CKD is a well-known comorbidity in chronic heart failure, associated with lower survival rates, while cardiovascular complications are the leading cause of death among patients with CKD. The ability to identify early CKD in patients with CHF is critical for estimating prognosis, developing treatment strategy and tactics, and ultimately for preventing cardiovascular and renal complications. Considering the CKD prevalence in CHF, it is important to develop strategies for the administration of renin-angiotensin-aldosterone system inhibitors in view of their nephroprotective action with antiproteinuric and antiproliferative effects that can be also associated with improved survival. An angiotensin converting enzyme inhibitor such as fosinopril appears particularly beneficial for the treatment of CHF patients. Fosinopril undergoes enzymatic hydrolysis primarily in the liver and gastrointestinal mucosa and is converted to fosinoprilat which is eliminated equally by the kidneys and liver. In patients with renal dysfunction, the decreased fosinoprilat elimination with urine is compensated by the increased hepatic metabolism. Fosinoprilat exhibits less accumulation than enalapril or lisinopril in patients with CDK. KEYWORDS: chronic heart failure, renal function, chronic kidney disease, fosinopril, fosinoprilat, nephroprotection. FOR CITATION: Khadzegova A.B. Renal function in patients with heart failure — a predictor for selecting RAAS inhibitors. Russian Medical Inquiry. 2023;7(1):30–35 (in Russ.). DOI: 10.32364/2587-6821-2023-7-1-30-35.