ReviewHeart (British Cardiac Society)2019
Change in renal function associated with drug treatment in heart failure: national guidance.
Review in Heart (British Cardiac Society), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04170855 (Evaluation of Kidney Medullary Sodium Content Using 23Na MRI to Understand and Predict Diuretic Resistance), which is not on this map. Cited by 49 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Evaluation of Kidney Medullary Sodium Content Using 23Na MRI to Understand and Predict Diuretic Resistance
Who cites it
49 citing papers in PubMed, 2 syntheses or guidelines pooled it, 93 citations in OpenAlex.
- Guideline
- Central and peripheral arterial diseases in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.Kidney international · 2021Guideline
- Adjudication of Hospitalizations and Deaths in the IRONMAN Trial of Intravenous Iron for Heart Failure.Journal of the American College of Cardiology · 2024Trial
- Renin-angiotensin system inhibitors (RASi) are not nephrotoxic - they protect the kidneys and the heart.Clinical medicine (London, England) · 2026Review
- Preventable Hospitalizations and Kidney Care.Clinical journal of the American Society of Nephrology : CJASN · 2026Review
- Treatment gaps in guideline-directed medical therapy for HFrEF in Singapore: findings from a multicentre retrospective cohort study.BMJ open · 2026Observational
- A rapid review and narrative synthesis of the evidence for oral sodium chloride supplements in the management of heart failure.European heart journal open · 2026Article
- Effectiveness and safety of combining thiazides with loop diuretics vs. loop diuretics monotherapy in patients with acute decompensated heart failure: A retrospective cohort study.British journal of clinical pharmacology · 2026Article
- Clinical Features and Outcomes of Patients with Heart Failure and Advanced Chronic Kidney Disease.Journal of clinical medicine · 2025Article
- Direction of global health status: a narrative review and recommendation for incorporating integrative medicine for improvement.Journal of medicine and life · 2025Review
- Adherence to the ABC (atrial fibrillation better care) pathway and risk of adverse outcomes in patients with chronic kidney disease: a report from the prospective APHRS-AF registry.The Lancet regional health. Western Pacific · 2025Article
- Article
- Unveiling the Systemic Impact of Congestion in Heart Failure: A Narrative Review of Multisystem Pathophysiology and Clinical Implications.Journal of cardiovascular development and disease · 2025Review
- Risk factors for and outcomes of acute kidney injury in ward-based hospital trauma admissions: A retrospective cohort analysis.PloS one · 2025Article
- Crosstalk: Biochemical Signatures and Clinical Implications in Rare Hereditary Hemolytic Anemias (Hereditary Spherocytosis).Current pharmaceutical design · 2025Article
- Acute kidney injury in acute heart failure-when to worry and when not to worry?Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2024Review
- Targeting Sodium in Heart Failure.Journal of personalized medicine · 2024Review
- Ischaemic Cardiomyopathy Secondary to Asymptomatic Coronary Artery Disease: A Case Report.Cureus · 2024Article
- Cardiorenal Syndromes and Their Role in Water and Sodium Homeostasis.Physiological research · 2024Review
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 6 institutions in 1 country.
Funding
Abstract
Inhibitors of the renin-angiotensin-aldosterone (RAAS) system are cornerstones of the management of patients with heart failure with reduced left ventricular ejection fraction (HFrEF). However, RAAS inhibitors may cause decline in renal function and/or hyperkalaemia, particularly during initiation and titration, intercurrent illness and during worsening of heart failure. There is very little evidence from clinical trials to guide the management of renal dysfunction. The Renal Association and British Society for Heart Failure have collaborated to describe the interactions between heart failure, RAAS inhibitors and renal dysfunction and give clear guidance on the use of RAAS inhibitors in patients with HFrEF. During initiation and titration of RAAS inhibitors, testing renal function is mandatory; a decline in renal function of 30% or more can be acceptable. During intercurrent illness, there is no evidence that stopping RAAS inhibitor is beneficial, but if potassium rises above 6.0 mmol/L, or creatinine rises more than 30%, RAAS inhibitors should be temporarily withheld. In patients with fluid retention, high doses of diuretic are needed and a decline in renal function is not an indication to reduce diuretic dose: if the patient remains congested, more diuretics are required. If a patient is hypovolaemic, diuretics should be stopped or withheld temporarily. Towards end of life, consider stopping RAAS inhibitors. RAAS inhibition has no known prognostic benefit in heart failure with preserved ejection fraction. Efforts should be made to initiate, titrate and maintain patients with HFrEF on RAAS inhibitor treatment, whether during intercurrent illness or worsening heart failure.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.