PDEV inhibition falls short of improving renal response in patients with preheart failure

The use of a phosphodiesterase type 5 (PDEV) inhibitor in patients with preheart failure (pre-HF) does not appear to produce improvements in glomerular filtration rate and urinary sodium/cGMP excretion as compared with placebo, as shown in a study.

To examine whether PDEV inhibition would improve renal function and cardiorenal response after short‐term volume load, researchers randomized 20 patients with pre-HF (defined as an ejection fraction ≤45 percent without previous diagnosis of heart failure) and renal impairment to receive tadalafil (goal dose 20 mg daily) or placebo for 12 weeks.

Patients in the tadalafil group were older than those in the placebo group (median age 71 vs 64 years), and 65 percent of the cohort overall were men. The median left ventricular ejection fraction (LVEF) in both groups was ≈37 percent. There were no significant differences in baseline laboratory measures of kidney and humoral function.

The median tadalafil dose achieved was 15 mg daily. The tadalafil dose achieved was 20 mg daily for six patients, 15 mg daily for two patients, 10 mg daily for two patients, and 5 mg daily for four patients.

Compared with placebo, treatment with tadalafil had no pronounced effect on glomerular filtration rate (median increase, 2.0 vs 13.5 mL/min; p=0.54). There was also no between-group difference in urinary sodium or cGMP excretion following short‐term saline loading.

These findings do not support the use of PDEV inhibition to enhance renal response in patients with pre-HF.