Renal function monitoring in heart failure – what is the optimal frequency? A narrative review

Abstract

The second most common cause of hospitalisation due to adverse drug reactions in the UK is renal dysfunction due to diuretics, particularly in patients with heart failure, where diuretic therapy is a mainstay of treatment regimens. Therefore the optimal frequency for monitoring renal function in these patients is an important consideration for preventing renal failure and hospitalisation. This review looks at the current evidence for optimal monitoring practices of renal function in patients with heart failure according to national and international guidelines on the management of heart failure (AHA/NICE/ESC/SIGN). Current guidance of renal function monitoring is in large part based on expert opinion, with a lack of clinical studies that have specifically evaluated the optimal frequency of renal function monitoring in patients with heart failure. Furthermore, there is variability between guidelines, and recommendations are typically non-specific. Safer prescribing of diuretics in combination with other anti-heart failure treatments requires better evidence for frequency of renal function monitoring. We suggest developing more personalised monitoring rather than from the current medication-based guidance. Such flexible clinical guidelines could be implemented using intelligent clinical decision support systems. Personalised renal function monitoring would be more effective in preventing renal decline, rather than reacting to it.

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