Pharmacoepidemiology in Cardiorenal Medicine

Cardiorenal syndrome (CRS) describes the phenomenon of joint dysfunction of the heart and kidneys and occurs when the acute or chronic dysfunction of one organ subsequently triggers acute or chronic dysfunction in the other. The majority of patients with chronic kidney disease (CKD) succumb to cardiovascular complications. Many pharmacologic agents influence the natural history of both CKD and heart disease through a variety of mechanisms. In this chapter, we provide an overview of pharmacological therapies available for patients with heart failure (HF) and adaptations employed for patients with CRS, as well as common themes contributing to the drugs’ underutilization. Therapies utilized for the management of HF may include angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), beta adrenergic receptor blockers, mineralocorticoid receptor antagonists (MRAs), diuretics, statins, digoxin, and sodium-glucose transport protein 2 (SGLT2) inhibitors. Many of these classes (or particular drugs within the class) have dosing guidelines specifically based on the degree of renal impairment. Although these drugs have been associated with decreased cardiovascular morbidity and mortality, they remain underutilized. Several factors prevent patients from receiving optimal drug therapy, some of which may be attributable to pill burden, poor comprehension and affordability, risk of side effects (which often increase with concomitant kidney dysfunction), and contextual issues faced by the prescribing physician.