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Heart failure - chronic - Management
How should I manage someone with renal impairment as a comorbidity in heart failure?
- Renal impairment is common in people with heart failure and is strongly associated with increased morbidity and mortality.
- Assess the underlying cause and manage potentially reversible causes. Possible causes include:
- Dehydration — consider a reduction in the dose of diuretic, or temporary cessation of the diuretic.
- Deterioration due to an angiotensin-converting enzyme inhibitor or angiotensin-II receptor antagonist — consider reducing the dose or stopping the drug.
- Coincident renal disease (such as diabetic nephropathy or renovascular disease) — undertake investigations as appropriate.
- Use aldosterone antagonists with caution in people with renal impairment because these drugs may cause clinically significant hyperkalaemia. Monitor serum potassium closely.
- Renal impairment is associated with impaired clearance of digoxin — to avoid toxicity, consider reducing the dose of digoxin and monitoring for signs and symptoms of toxicity.
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