ISSN 2415-3060 (print), ISSN 2522-4972 (online)
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JMBS 2019, 4(5): 142–148
https://doi.org/10.26693/jmbs04.05.142
Clinical Medicine

Factors Associated with the Development of Cardiorenal Syndrome Type 2 in Chronic Heart Failure and Preserved Contractional Function of the Left Ventricle

Lazidi E. L., Rudyk Iu. S.
Abstract

The purpose of the study was to investigate and evaluate the factors associated with type 2 cardiorenal syndrome in chronic heart failure and preserved contractional function of the left ventricle. Material and methods. The prospective study included 146 people with chronic heart failure and preserved contractional function (114 women (78.0%) and 62 men (22.0%), the average age was 62.0 ± 12.3 years). We used clinical, functional, instrumental and laboratory methods. Glomerular rate filtration was assessed according to the Cockroft-Golt formula. Reduced renal function was considered in cases with glomerular rate filtration less than 60 ml/min/m2. For statistical analysis we used software Statistica for Windows version 7.0 (Stat Soft inc., USA). Parameters are presented as mean ± standard deviation. The risk assessment for adverse event presents as absolute and relative risks and odds ratios; differences were statistically significant with p<0.05. Results and discussion. The obtained results showed that factors associated with a high risk of cardiorenal syndrome in patients with heart failure were in the age older than 55 years and body mass index more than 32 kg/m2, (p<0.05). The probable inverse correlation between kidney function and body mass index in patients with heart failure was (r = -0.32, p<0.05). The increase in the expected frequency from 0.2 to 0.48 events in the form of chronic kidney disease by 100.0 cases of chronic heart failure was set by the body mass index when it increased from 24.9 to 30.0 units. The laboratory parameters proved that the risk low glomerular rate filtration rate in patients with cardiorenal syndrome was obtained at lower level of hemoglobin and hematocrit (p<0.05). Hyponatremia was set as probable risk factor for type 2 cardiotrenal syndrome in patients with chronic heart failure: 36.0% versus 24.0%, relative risk - 1.47 [1.01-2.14] (p<0.05), odds ratio - 1.74 [1.0-3.02] (p <0.05). Reducing sodium levels below 125 mmol/l increased the risk of cardiorenal syndrome by 47.0%. Conclusions. The study established direct correlation between the aldosterone and creatinine level (r = 0.41, p<0.05), reversed relationship between aldosterone and glomerular filtration rate (r = -0.43, p<0.05). We propose linear regression model between the content of proBNP, aldosterone and the level of glomerular filtration rate in patients with glomerular filtration rate: aldosteron = 68.08-GFR*0,049; NTproBNP = 399.35-GFR * 0.151.

Keywords: chronic heart failure, cardiorenal syndrome, glomerular rate filtration

Full text: PDF (Ukr) 341K

References
  1. Chawla LS, Eggers PW, Star RA, Kimmel P. Acute kidney injury and chronic kidney disease as interconnected syndromes. N Engl J Med. 2014; 371(1): 58-66. https://www.ncbi.nlm.nih.gov/pubmed/24988558. https://doi.org/10.1056/NEJMra1214243
  2. Damman K, Testani JM. The kidney in heart failure: an update. Eur Heart J. 2015; 36(23): 1437-44. https://www.ncbi.nlm.nih.gov/pubmed/25838436. https://www.ncbi.nlm.nih.gov/pmc/articles/4465636. https://doi.org/10.1093/eurheartj/ehv010
  3. Testani JM, Kimmel SE, Dries DL, Coca SG. Prognostic importance of early worsening renal function after initiation of angiotensin-converting enzyme inhibitor therapy in patients with cardiac dysfunction. Circ Heart Fail. 2011; 4(6): 685-91. https://www.ncbi.nlm.nih.gov/pubmed/21903907. https://www.ncbi.nlm.nih.gov/pmc/articles/3248247. https://doi.org/10.1161/CIRCHEARTFAILURE.111.963256
  4. Vesnina ZhV, Arseneva YuA. Kardiorenalnyy sindrom: sovremennye vzglyady na problemu vzaimosvyazi zabolevaniy pochek i serdechno-sosudistoy sistemy [Cardiorenal syndrome: current views on the relationship of kidney disease and the cardiovascular systemy]. Klinicheskaya meditsina. 2012; 7: 8-14. [Russian]
  5. McCullough PA, Haapio M, Mankad S, Zamperetti N, Massie B, Bellomo R, et al. Prevention of cardio-renal syndromes: workgroup statements from the 7 th ADQI Consensus Conference. Nephrol Dial Transplant. 2010; 25(6): 1777-84. https://doi.org/10.1093/ndt/gfq180
  6. Xue Y, Xu B, Su C, Han Q, Wang T, Tang W. Cardiorenal syndrome in incident peritoneal dialysis patients: What is its effect on patients' outcomes? PLoS One. 2019; 14(6): e0218082. https://www.ncbi.nlm.nih.gov/pubmed/31173609. https://www.ncbi.nlm.nih.gov/pmc/articles/6555513. https://doi.org/10.1371/journal.pone.0218082
  7. Agrawal A, Naranjo M, Kanjanahattakij N, Rangaswami J, Gupta S. Cardiorenal syndrome in heart failure with preserved ejection fraction-an under-recognized clinical entity. Heart Fail Rev. 2019; 24(4): 421-37. https://www.ncbi.nlm.nih.gov/pubmed/31127482. https://doi.org/10.1007/s10741-018-09768-9
  8. Brandenburg V, Heine GH. The Cardiorenal Syndrome. Dtsch Med Wochenschr. 2019; 144(6): 382-6. https://www.ncbi.nlm.nih.gov/pubmed/30870868. https://doi.org/10.1055/a-0661-4456
  9. Ronco C, Bellasi A, Di Lullo L. Cardiorenal Syndrome: An Overview. Adv Chronic Kidney Dis. 2018; 25(5): 382-90. https://www.ncbi.nlm.nih.gov/pubmed/30309455. https://doi.org/10.1053/j.ackd.2018.08.004
  10. McCullough PA, Li S, Jurkovitz CT, Stevens LA, Wang C, Collins AJ, et al. CKD and cardiovascular disease in screened high risk volunteer and general populations: the Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999-2004. Am J Kidney Dis. 2008; 51(4 Suppl 2): S 38-45. https://doi.org/10.1053/j.ajkd.2007.12.017
  11. Kovesdi KP, Furs S, Zokkali K. Ozhirenie i zabolevanie pochek: skrytye posledstviya epidemii [Obesity and kidney disease: the hidden consequences of the epidemic]. Klinicheskaya nefrologiya. 2017; 1: 3-11. [Russian] https://doi.org/10.1111/jorc.12194
  12. Kutyrina IM, Kryachkova AA, Saveleva SA, Shestakova MV. Rol aldosterona v porazhenii pochek pri metabolicheskom sindrome, assotsiirovannom s porazheniem pochek [The role of aldosterone in kidney damage in metabolic syndrome associated with kidney damage]. Klinicheskaya nefrologiya. 2010; 4: 34-44. [Russian]
  13. Reznik EV, Nikitin IG. Kardiorenalnyy sindrom u bolnykh s serdechnoy nedostatochnostyu kak etap kardiorenalnogo kontinuuma (chast I): opredelenie, klassifikatsiya, patogenez, diagnostika, epidemiologiya (obzor literatury) [Cardiorenal syndrome in patients with heart failure as a stage of the cardiorenal continuum (part I): definition, classification, pathogenesis, diagnosis, epidemiology (literature review)]. Arkhiv vnutrenney meditsiny. 2019; 9(1): 5-22. [Russian] https://doi.org/10.20514/2226-6704-2019-9-1-5-22
  14. Schrier RW, Gross P, Gheorghiade M, Berl T, Verbalis JG, Czerwiec FS, et al. Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia. N Engl J Med. 2006; 355(20): 2099-112. https://www.ncbi.nlm.nih.gov/pubmed/17105757. https://doi.org/10.1056/NEJMoa065181
  15. Reznik EV. Pochki kak organ-mishen pri khronicheskoy serdechnoy nedostatochnosti [Kidneys as a target organ in chronic heart failure]. Lamber; 2011. 188 p. [Russian]