Clinical observation of ivabradine in the treatment of chronic heart failure in end-stage renal disease patients undergoing maintenance hemodialysis

TAN Gang; LI Yongfang; ZHOU Guangpeng

doi:10.6039/j.issn.1001-0408.2025.01.15

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Clinical observation of ivabradine in the treatment of chronic heart failure in end-stage renal disease patients undergoing maintenance hemodialysis

更新时间：2025-09-25

- Clinical observation of ivabradine in the treatment of chronic heart failure in end-stage renal disease patients undergoing maintenance hemodialysis
- ZHONGGUO YAOFANG Vol. 36, Issue 1, Pages: 91-95(2025)
- 作者机构：
  
  1.四川省医学科学院/四川省人民医院心血管内科，成都　610072
  2.四川省医学科学院/四川省人民医院内镜室，成都　610072
  3.四川省医学科学院/四川省人民医院内分泌科，成都　610072
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2025.01.15
  CLC： R972;R969.4
- Received：21 August 2024，
  
  Revised：2024-12-24，
  
  Accepted：24 December 2024，
  
  Published：15 January 2025
- 稿件说明：
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谭刚,李永芳,周广朋.伊伐布雷定治疗维持性血液透析期间合并慢性心力衰竭的终末期肾病患者的临床观察[J].中国药房,2025,36(01):91-95.

TAN Gang,LI Yongfang,ZHOU Guangpeng.Clinical observation of ivabradine in the treatment of chronic heart failure in end-stage renal disease patients undergoing maintenance hemodialysis[J].ZHONGGUO YAOFANG,2025,36(01):91-95.
谭刚,李永芳,周广朋.伊伐布雷定治疗维持性血液透析期间合并慢性心力衰竭的终末期肾病患者的临床观察[J].中国药房,2025,36(01):91-95. DOI： 10.6039/j.issn.1001-0408.2025.01.15.

TAN Gang,LI Yongfang,ZHOU Guangpeng.Clinical observation of ivabradine in the treatment of chronic heart failure in end-stage renal disease patients undergoing maintenance hemodialysis[J].ZHONGGUO YAOFANG,2025,36(01):91-95. DOI： 10.6039/j.issn.1001-0408.2025.01.15.

摘要

目的

考察伊伐布雷定治疗维持性血液透析（MHD）期间合并慢性心力衰竭（CHF）的终末期肾病患者的有效性和安全性。

方法

选择2021年5月至2023年9月在我院治疗且符合纳入标准的MHD期间合并CHF的终末期肾病患者作为研究对象，采用随机数字表法将其分为对照组和观察组，各60例。两组患者均接受MHD，每次4 h，每周3次，并采用低分子量肝素钠抗凝，同时均予以CHF常规治疗方案；观察组患者在上述治疗基础上口服盐酸伊伐布雷定片5 mg，每天2次（2周后若静息心率高于60次/min，则药物剂量增加至7.5 mg，每天2次）。两组患者均连续治疗6个月。比较两组患者的临床疗效，治疗前后生命体征、心功能、心力衰竭相关标志物水平、炎症因子水平，透析相关低血压发生率及药物不良反应总发生率。

结果

观察组患者的有效率（92.45%）显著高于对照组（76.47%），透析相关低血压发生率（20.75%）显著低于对照组（41.18%）（

＜0.05）。观察组患者治疗后的心率、左室收缩末内径、左室舒张末内径和血清氨基末端脑利钠肽前体、癌抗原125、肿瘤坏死因子α、白细胞介素6、超敏C反应蛋白水平均显著低于或小于对照组（

＜0.05）；左室射血分数、心输出量均显著高于对照组（

＜0.05）。两组患者治疗后的舒张压、收缩压以及治疗期间药物不良反应总发生率比较，差异均无统计学意义（

＞0.0

5）。

结论

伊伐布雷定可显著改善MHD期间合并CHF的终末期肾病患者的心功能，抑制心室重塑，下调患者血清氨基末端脑利钠肽前体、癌抗原125水平，降低机体炎症水平以及透析相关低血压发生率，临床效果显著且安全性良好。

Abstract

OBJECTIVE

To investigate the efficacy and safety of ivabradine in the treatment of end-stage renal disease patients with chronic heart failure （CHF） during maintenance hemodialysis （MHD）.

METHODS

End-stage renal disease patients with CHF during MHD who were treated in our hospital from May 2021 to September 2023 and met the inclusion criteria were selected as the study subjects. They were randomly divided into control group and observation group， with 60 cases in each group， using a random number table method. Both groups of patients received MHD three times a week for 4 hours each time and were anticoagulated with low-molecular weight heparin sodium. At the same time， they were treated with CHF conventional therapy； based on the above treatment， observation group was orally administered Ivabradine tablets 5 mg， twice a day （if the resting heart rate was above 60 beats/min after 2 weeks， the drug dose was increased to 7.5 mg， twice a day）. Both groups of patients were treated continuously for 6 months. The clinical efficacy of 2 groups was compared as well as vital signs， cardiac function， the levels of heart failure-related biomarkers and inflammatory factors before and after treatment， and the incidences of dialysis-related hypotension and adverse drug reactions.

RESULTS

The effective rate of the observation group （92.45%） was significantly higher than that of the control group （76.47%）， and the incidence of dialysis-related hypotension （20.75%） was significantly lower than that of the control group （41.18%）（

＜0.05）. The heart rate， the levels of left ventricular end-systolic diameter， left ventricular end-diastolic diameter， serum N-terminal pro-B-type natriuretic peptide， cancer antigen 125， tu

mor necrosis factor-α， interleukin-6， and hypersensitive C-reactive protein in observation group after treatment were significantly lower than those of control group （

＜0.05）； the left ventricular ejection fraction and cardiac output were significantly higher than those in the control group （

＜0.05）. There was no statistically significant difference in the diastolic blood pressure， systolic blood pressure， or the total incidence of adverse drug reactions between the two groups after treatment （

＞0.05）.

CONCLUSIONS

Ivabradine can significantly improve cardiac function， inhibit ventricular remodeling， down-regulate serum levels of serum N-terminal pro-B-type natriuretic peptide and cancer antigen 125， decrease body inflammation levels and the incidence of dialysis-related hypotension in end-stage renal disease patients with CHF during MHD， with significant clinical effects and good safety.

关键词

Keywords

references

AGARWAL A K ， ROY-CHAUDHURY P ， MOUNTS P ， et al . Taurolidine/heparin lock solution and catheter-related bloodstream infection in hemodialysis：a rando- mized，double-blind，active-control，phase 3 study [J ] . Clin J Am Soc Nephrol ， 2023 ， 18 （ 11 ）： 1446 - 1455 .

HOUSE A A ， WANNER C ， SARNAK M J ， et al . Heart failure in chronic kidney disease：conclusions from a kidney disease：improving global outcomes （KDIGO） controversies conference [J ] . Kidney Int ， 2019 ， 95 （ 6 ）： 1304 - 1317 .

KAWASAKI S ， SAKAI Y ， HARASAWA S ， et al . The efficacy and safety of ivabradine hydrochloride in hemodialysis patients with chronic heart failure [J ] . Ther Apher Dial ， 2024 ， 28 （ 3 ）： 354 - 363 .

李东义，李鹍，余东林 . 伊伐布雷定片联合托伐普坦片治疗急性心肌梗死合并心力衰竭患者的临床研究 [J ] . 中国临床药理学杂志， 2023 ， 39 （ 7 ）： 928 - 931 .

LI D Y ， LI K ， YU D L . Clinical trial of ivabradine tablets and tolvaptan tablets in the treatment of patients with acute myocardial infarction with heart failure [J ] . Chin J Clin Pharmacol ， 2023 ， 39 （ 7 ）： 928 - 931 .

王华，杨杰孚 . LCZ696和伊伐布雷定推荐级别提升：2016年ACC/AHA/HFSA心衰新型药物治疗指南更新解读 [J ] . 中国循环杂志， 2016 ， 31 （增刊2 ）： 15 - 17 .

WANG H ， YANG J F . LCZ696 and ivabradine recommendation level upgrade：interpretation of the 2016 ACC/AHA/HFSA new drug treatment guidelines for heart fai- lure [J ] . Chin Circ J ， 2016 ， 31 （ Suppl.2 ）： 15 - 17 .

CHAWLA L S ， HERZOG C A ， COSTANZO M R ， et al . Proposal for a functional classification system of heart failure in patients with end-stage renal disease：procee- dings of the Acute Dialysis Quality Initiative （ADQI） Ⅺ Workgroup [J ] . J Am Coll Cardiol ， 2014 ， 63 （ 13 ）： 1246 - 1252 .

孙长丽，董洋，王丽姣，等 . 沙库巴曲缬沙坦治疗维持性血液透析合并心力衰竭的临床疗效 [J ] . 中华肾脏病杂志， 2022 ， 38 （ 1 ）： 15 - 22 .

SUN C L ， DONG Y ， WANG L J ， et al . Clinical efficacy of angiotensin-receptor neprilysin inhibitors in the treatment of maintenance hemodialysis with heart failure [J ] . Chin J Nephrol ， 2022 ， 38 （ 1 ）： 15 - 22 .

TAUB P R ， ZADOURIAN A ， LO H C ， et al . Randomized trial of ivabradine in patients with hyperadrenergic postural orthostatic tachycardia syndrome [J ] . J Am Coll Cardiol ， 2021 ， 77 （ 7 ）： 861 - 871 .

FONTENLA A ， TAMARGO J ， SALGADO R ， et al . Ivabradine for controlling heart rate in permanent atrial fibrillation：a translational clinical trial [J ] . Heart Rhythm ， 2023 ， 20 （ 6 ）： 822 - 830 .

DRECHSLER C ， MEINITZER A ， PILZ S ， et al . Homoarginine，heart failure，and sudden cardiac death in haemo- dialysis patients [J ] . Eur J Heart Fail ， 2011 ， 13 （ 8 ）： 852 - 859 .

YE F M ， WANG X F ， WU S L ， et al . Sustained-release ivabradine hemisulfate in patients with systolic heart failure [J ] . J Am Coll Cardiol ， 2022 ， 80 （ 6 ）： 584 - 594 .

黄宇玲，荣萍萍，李挺，等 . 心力衰竭患者出院静息心率对全因死亡的影响 [J ] . 中国循环杂志， 2023 ， 38 （ 4 ）： 434 - 440 .

HUANG Y L ， RONG P P ， LI T ， et al . Association between discharge resting heart rate and all-cause mortality in patients with heart failure [J ] . Chin Circ J ， 2023 ， 38 （ 4 ）： 434 - 440 .

VIRMANI S ， MALLIK I ， MOHIRE V B ， et al . Effect of preoperative ivabradine on hemodynamics during elective off-pump CABG [J ] . Ann Card Anaesth ， 2024 ， 27 （ 2 ）： 183 - 184 .

ORDU S ， YILDIZ B S ， ALIHANOGLU Y I ， et al . Effects of ivabradine therapy on heart failure biomarkers [J ] . Cardiol J ， 2015 ， 22 （ 5 ）： 501 - 509 .

张勇，唐海沁，李瑾 . 老年慢性心力衰竭患者血浆B型利钠肽与糖类抗原125水平的变化 [J ] . 中华老年医学杂志， 2013 ， 32 （ 5 ）： 473 - 475 .

ZHANG Y ， TANG H Q ， LI J . Changes in plasma B-type natriuretic peptide and carbohydrate antigen 125 levels in elderly chronic heart failure [J ] . Chin J Geriatr ， 2013 ， 32 （ 5 ）： 473 - 475 .

文贤，曾显峰，苏蕊雅 . 伊伐布雷定片联合左西孟旦在急性心肌梗死合并心力衰竭患者中的应用 [J ] . 实用医学杂志， 2024 ， 40 （ 2 ）： 242 - 247 .

WEN X ， ZENG X F ， SU R Y . Efficacy of ivabradine combined with levosimendan in patients with acute myocardial infarction complicated with heart failure [J ] . J Pract Med ， 2024 ， 40 （ 2 ）： 242 - 247 .

SOHN P ， NARASAKI Y ， RHEE C M . Intradialytic hypotension：is timing everything? [J ] . Kidney Int ， 2021 ， 99 （ 6 ）： 1269 - 1272 .

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