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. Author manuscript; available in PMC: 2023 Mar 1.
Published in final edited form as: Circulation. 2022 Feb 28;145(9):693–712. doi: 10.1161/CIRCULATIONAHA.121.052792

Figure 3. Conceptual overview of evidence based treatments in HFrEF according to baseline CKD status.

Figure 3.

With more severe CKD stages, prognosis worsens, and scientific evidence becomes scarce. There is more evidence for CKD stage 1–4 for preventing CV Death/HF Hospitalization with evidence based treatments as compared with preventing all-cause mortality. Among treatments there is some evidence for efficacy of SGLT2i, omecamtiv-mecarbil, ACEi, digoxin and vericiguat in CKD stage 4. Overall the renal safety profile in all classes of CKD with essentially all treatments is good, if the clinical status is taken into account and renal function and potassium are checked regularly. Loop Diuretics are not depicted in the absence of large randomized placebo controlled trials.

Abbreviations: ACEi: Angiotensin Converting Enzyme Inhibitor, ARB: Angiotensin II Receptor Blocker, ARNI: Angiotensin Receptor blocker neprilysin Inhibitor, Beta-blocker: Beta-Blocker, CV: Cardiovascular, eGFR: Estimated Glomerular Filtration Rate, H-ISDN: Hydralazine IsosorbideDinitrate, HR: Hazard Ratio, HF: Heart Failure, MRA: Mineralocorticoid Receptor Antagonist, SGLT2i: Sodium glucose co-transporter 2 inhibitor.