Priority 22 from the Advanced Heart Failure PSP

UNCERTAINTY: How do health professionals best manage chronic kidney disease and advanced heart failure?  a. What medication is best to use?  b. How to manage diuretics c. Is metolazone or iv furosemide better? (JLA PSP Priority 22)
Overall ranking 22
JLA question ID 0098/22
Explanatory note

The evidence around this topic area is hospital based - the evidence that is lacking is care in the community  


1. Heart Lung Circ. 2018 Aug;27(8):928-939. doi: 10.1016/j.hlc.2017.12.013. Epub 2018 Feb 13.Tolvaptan for Heart Failure in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis.

2. J Card Fail. 2007 Oct;13(8):599-608.Worsening renal function and prognosis in heart failure: systematic review and meta-analysis.Damman K1, Navis G, Voors AA, Asselbergs FW, Smilde TD, Cleland JG, van Veldhuisen DJ, Hillege HL.

3. J Am Coll Cardiol. 2006 May 16;47(10):1987-96. Epub 2006 Apr 24.Renal impairment and outcomes in heart failure: systematic review and meta-analysis.Smith GL1, Lichtman JH, Bracken MB, Shlipak MG, Phillips CO, DiCapua P, Krumholz HM.

Health Research Classification System category  Cardiovascular
Extra information provided by this PSP
Original uncertainty examples Is weighing daily an effective monitoring tool? How to improve balancing the impact on chronic kidney disease and heart failure? ~ What medication is best to use with severe heart failure and renal impairment? ~ How to manage cardio-renal syndrome or those at risk of this - how best to manage diuretics in late stage heart failure  ~ How best to manage resistant fluid retention in advanced disease: 1. Parenteral furosemide or Metolazone: Which is more efficacious and less likely to worsen renal function? 2. Is SC Furosemide as effective as IV?
Submitted by  4 x health professionals 
PSP information
PSP unique ID 0098
PSP name Advanced Heart Failure
Total number of uncertainties identified by this PSP. 65  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 13 February 2019