Preview

Rational Pharmacotherapy in Cardiology

Advanced search

CARDIORENAL INTERACTION IN DECOMPENSATED CHRONIC HEART FAILURE

https://doi.org/10.20996/1819-6446-2016-12-2-138-146

Full Text:

Abstract

Aim. To investigate the prevalence of cardiorenal interactions, predictors of development, variants of clinical course, and outcomes of acute kidney injury (AKI) in patients with acute decompensation of chronic heart failure (ADCHF).
Material and methods. Patients (n=278) with clinical manifestations of ADCHF were included into the study. All patients underwent clinical, laboratory and instrumental investigation. Renal function was assessed using the CKD-EPI formula to calculate glomerular filtration rate (GFR). Hydration was assessed using the bioimpedance analyzer ABC-01 "Medass" (Russia). Chronic kidney disease (CKD) and AKI were diagnosed according to the criteria of the latest Russian and international guidelines. Six phenotypes of AKI were identified: outpatient and hospital acquired, transient and persistent, de novo, and on the background of CKD.
Results. CKD was detected in 125 (45%) patients. AKI developed in 121 (43.5%) patients, and in 52.9% of cases was nosocomial, in 53.7% transient and in 52.1% of cases occurred in patients without history of CKD. The risk of in-hospital mortality compared with patients without AKI significantly increased only in patients with nosocomial AKI (14.1 and 3.8%, p<0.05), AKI de novo (14.3 and 3.85%, p <0.05) and persistent (25 and 3.8%, p<0.001). Patients with these variants of AKI as compared to patients without AKI had more pronounced hydration, as well as less frequent prescription of loop diuretics and beta-blockers during outpatient treatment.
Conclusion. The high rate (67.6%) of cardiorenal interactions was found out in patients admitted to hospital with ADCHF. Unfavorable prognostic phenotypes of AKI were hospital acquired, persistent AKI and AKI de novo. Patients with these phenotypes had a more pronounced hydration and inadequate outpatient therapy.

About the Authors

Zh. D. Kobalava
Peoples’ Friendship University of Russia, Moscow
Russian Federation


S. V. Villevalde
Peoples’ Friendship University of Russia, Moscow
Russian Federation


M. A. Efremovtseva
Peoples’ Friendship University of Russia, Moscow
Russian Federation


References

1. Matsushita K., van der Velde M., Astor B.C. et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 2010; 375(9731): 2073-81.

2. Middleton R.J., Foley R.N., Hegarty J. et al. The unrecognized prevalence of chronic kidney disease in diabetes. Nephrol Dial Transplant 2006; 21: 88-92.

3. Segura J., Garcia-Donair J., Praga M., Ruilope L.M. Chronic kidney disease as a situation of high added risk in hypertensive patients. J Am Soc Nephrol 2006; 17 (Suppl 2): 136-40.

4. Go A.S., Chertow G.M., Fan D. et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351: 1296-305.

5. Collins A.J., Vassalotti J.A., Wang C. et al. Who should be targeted for CKD screening? Impact of diabetes, hypertension, and cardiovascular disease. Am J Kidney Dis 2009; 53 (Suppl 3): 71-7.

6. Herzog C. Kidney disease in cardiology. Nephrol Dial Transplant 2008; 23(8): 42-6.

7. McCullough P.A., Li S., Jurkovitz C.T. 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 (Suppl 2): 38-45.

8. Foley R., Murray A., Li S. et al. Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the United States Medicare population, 1998 to 1999. J Am Soc Nephrol 2005; 16: 489-95.

9. McClellan W.M., Resnick B., Lei L. et al. Prevalence and severity of chronic kidney disease and anemia in the nursing home population. J Am Med Dir Assoc 2010; 11: 33-41.

10. Collins A.J., Foley R.N., Herzog C. et al. United States Renal Data System 2008 Annual Data Report. Am J Kidney Dis 2009; 53: 1-374.

11. Gottlieb S.S., Abraham W., Butler J. et al. The prognostic importance of different definitions of worsening renal function in congestive heart failure. J Card Fail 2002; 8: 136-41.

12. Jose P., Skali H., Anavekar N. et al. Increase in creatinine and cardiovascular risk in patients with systolic dysfunction after myocardial infarction. J Am Soc Nephrol 2006; 17: 2886-91.

13. Latchamsetty R., Fang J., Kline-Rogers E. et al. Prognostic value of transient and sustained increase in in-hospital creatinine on outcomes of patients admitted with acute coronary syndrome. Am J Cardiol 2007; 99(7): 939-42.

14. Lassnigg A., Schmid E.R., Hiesmayr M. et al. Impact of minimal increases in serum creatinine on outcome in patients after cardiothoracic surgery: do we have to revise current definitions of acute renal failure? Crit Care Med 2008; 36: 1129-37.

15. Smith G.L., Vaccarino V., Kosiborod M. et al. Worsening renal function: What is a clinically meaningful change in creatinine during hospitalization with heart failure? J Card Fail. 2003; 9: 13-25.

16. Mehta R.L., Kellum J.A., Shah S.V. et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11: R31.

17. Bellomo R., Ronco C., Kellum J.A. et al. Acute renal failure definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004; 8: 204-12.

18. Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int., (Suppl) 2012; 2: 1-138.

19. Ronco C., McCullough P., Anker S. et al. Acute Dialysis Quality Initiative (ADQI) consensus group. Cardio-renal syndromes: report from the consensus conference of the Acute Dialysis Quality Initiative. Eur Heart J 2010; 31: 703-11.

20. Zhou Q., Zhao C., Xie D. et al. Acute and acute-on-chronic kidney injury of patients with decompensated heart failure: impact on outcomes. BMC Nephrology 2012; 13: 51.

21. Virzì G.M., Clementi A., Brocca A. et al. The hemodynamic and nonhemodynamic crosstalk in car- diorenal syndrome type 1. Cardiorenal Med 2014; 4:103-12.

22. Haase M., Muller C., Damman K. et al. Pathogenesis of cardiorenal syndrome type 1 in acute decompensated heart failure: workgroup statements from the eleventh consensus conference of the Acute Dialysis Quality Initiative (ADQI). Contrib Nephrol 2013; 182: 99-116.

23. Hillege H.L., Girbes A.R., De Kam P.J. et al. Renal function, neurohormonal activation, and survival in patients with chronic heart failure. Circulation 2000; 11: 203-10.

24. Schrier R.W., Abraham W.T. Hormones and hemodynamics in heart failure. N Engl J Med 1999; 341: 577-85.

25. Adams K.F., Fonarow G.C., Emerman C.L. et al. ADHERE Scientific Advisory Committee and Investigators. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the acute decompensated heart failure national registry (ADHERE). Am Heart J 2005; 149: 209-16.

26. Fonarow G.C., Stough W.G., Abraham W.T. et al. OPTIMIZE-HF Investigators and Hospitals. Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF registry. J Am Coll Cardiol 2007; 50: 768-77.

27. Massie B.M., O’Connor C.M., Metra M. et al. PROTECT Investigators and Committees. Rolofylline, an adenosine A1-receptorantagonist, in acute heart failure. N Engl J Med 2010; 363: 1419-28.

28. Chen H.H., Anstrom K.J., Givertz M.M. et al. NHLBI Heart Failure Clinical Research Network. Low-dose dopamine or low-dose nesiritide in acute heart failure with renal dysfunction: the ROSE acute heart failure randomized trial. JAMA 2013; 310: 2533-43.

29. Owan T.E., Hodge D.O., Herges R.M. et al. Secular trends in renal dysfunction and outcomes in hospitalized heart failure patients. J Card Fail 2006, 12: 257-62.

30. Forman D.E., Butler J., Wang Y. et al. Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure. J Am Coll Cardiol 2004, 43: 61-7.

31. Levey A.S., Stevens L.A., Schmid C.H. et al. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med 2009, 150: 604-12.

32. Mareev V.J., Ageev F.T., Arutjunov G.P. et al. National guidelines OSSN, the RKO and RNMOT for the diagnosis and treatment of chronic heart failure (fourth revision). Serdechnaja Nedostatochnost' 2013;

33. 7(81): 379-472. In Russian (Мареев В.Ю., Агеев Ф.Т., Арутюнов Г.П. и др. Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр). Сердечная Недостаточность 2013;7 (81): 379-472).

34. National guidelines. Chronic kidney disease: the basic principles of screening, diagnosis, prevention and treatment approaches. St.Peterburg: Levsha; 2012. In Russian (Национальные рекомендации. Хроническая болезнь почек: основные принципы скрининга, диагностики, профилактики и подходы к лечению. Санкт-Петербург: Левша; 2012).

35. Clinical guidelines. Cardiovascular risk and chronic kidney disease: cardiovascular nefroprotektsii strategy. Rossijskij Kardiologicheskij Zhurnal 2014; 8(112): 7-37. In Russian (Клинические рекомендации. Сердечно-сосудистый риск и хроническая болезнь почек: стратегии кардио-нефропротекции. Российский Кардиологический Журнал 2014; 8 (112): 7-37.

36. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int (Suppl) 2013; 3: 1-150.

37. Ahmed A., Rich M.W., Sanders P.W. et al. Chronic kidney disease associated mortality in diastolic versus systolic heart failure: a propensity matched study. Am J Cardiol 2007; 99: 393-8.

38. Roger V.L., Go A.S., Lloyd-Jones D.M. et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics 2011 update: a report from the American Heart Association. Circulation 2011; 123: e18e209.

39. Campbell R.C., Sui S., Filippatos G. et al. Association of chronic kidney disease with outcomes in chronic heart failure: a propensity-matched study. Nephrol Dial Transplant 2009; 24: 186-93.

40. Storrow A.B., Jenkins C.A., Self W.H. et al. The burden of acute heart failure on us emergency departments. JACC Heart Fail 2014; 2: 269e77.

41. Gottlieb S.S., Abraham W., Butler J. et al. The prognostic importance of different definitions of worsening renal function in congestive heart failure. J Card Fail 2002; 8: 136-41.

42. Krumholz H.M., Chen Y.T., Vaccarino V. et al. Correlates and impact on outcomes of worsening renal function in patients > or = 65 years of age with heart failure. Am J Card 2000; 85: 1110-13.

43. Cowie M.R., Komajda M., Murray-Thomas T. et al. Prevalence and impact of worsening renal function in patients hospitalized with decompensated heart failure: results of the prospective outcomes study in heart failure (POSH). Eur Heart J 2006; 27: 1216-22.

44. McCullough P.A., Kellum J.A., Mehta R.L. et al. ADQI Consensus on AKI Biomarkers and Cardiorenal Syndromes. Contrib Nephrol Basel Karger 2013; 182: 99-116.

45. Hsu C.Y., Chertow G.M., McCulloch C.E. et al. Nonrecovery of kidney function and death after acute on chronic renal failure. Clin J Am Soc Nephrol 2009; 4: 891-8.


For citation:


Kobalava Z.D., Villevalde S.V., Efremovtseva M.A. CARDIORENAL INTERACTION IN DECOMPENSATED CHRONIC HEART FAILURE. Rational Pharmacotherapy in Cardiology. 2016;12(2):138-146. (In Russ.) https://doi.org/10.20996/1819-6446-2016-12-2-138-146

Views: 553


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)