nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное обществоnid-1009Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESВзаимосвязь фибрилляции предсердий и дисфункции почек у больных с хронической сердечной недостаточностьюThe relationship of atrial fibrillation and renal function in patients with chronic heart failureГендлинГ. Е.GendlinG. E.noemail@neicon.ruРезникЕ. В.ReznikE. V.elenaresnik@gmail.com. RGMUGT2@mail.ruСторожаковГ. И.StorojhakovG. I.noemail@neicon.ruМелеховА. В.MelekhovA. V.noemail@neicon.ruУсковаО. В.UskovaO. V.noemail@neicon.ruФедоровскаяТ. В.FedorovskayaT. V.noemail@neicon.ruКафедра госпитальной терапии № 2 ГОУ ВПО РГМУ Росздрава, ГКБ № 12 г. МосквыРоссияDepartment of Internal diseases No 2, Russian State Medical University, Moscow city Hospital No 12Russian Federation201017062025124254261Copyright © Гендлин Г.Е., Резник Е.В., Сторожаков Г.И., Мелехов А.В., Ускова О.В., Федоровская Т.В., 20252025Гендлин Г.Е., Резник Е.В., Сторожаков Г.И., Мелехов А.В., Ускова О.В., Федоровская Т.В.Gendlin G.E., Reznik E.V., Storojhakov G.I., Melekhov A.V., Uskova O.V., Fedorovskaya T.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/1009

Цель работы: изучить влияние фибрилляции предсердий (ФП) на функциональное состояние почек, микроальбуминурию и почечную гемодинамику при хронической сердечной недостаточности (ХСН). Обследовано 118 больных с ХСН I–IV функциональных классов с фракцией выброса левого желудочка (ФВ ЛЖ) меньше 45% без первичной патологии почек, мочевыводящих путей, эндокринных и онкологических заболеваний. У 38% (95%ДИ 28,4–47,6%) была постоянная форма ФП. Больные с ФП и синусовым ритмом (СР) были сравнимы по полу, возрасту и ФВ ЛЖ. При этом у больных с ФП была ниже скорость клубочковой фильтрации – СКФ по формуле MDRD: 102,7 (97,8–108,2) и 98,5 (95,2–103,9) мл/мин/1,73 м2 – и выше экскреция альбумина с мочой: 16,7 (2,9–37) и 31,4 (17,3–44,7) мг/л. Показатели базального и общего объемного почечного кровотока (ПК), такие как объем крови, поступающий в основной ствол почечной артерии (ПА) в течение 1 сердечного цикла (SVk) и его индекс (SIk), были ниже при ФП, чем при синусовом ритме (СР) для базального ПК: SIk 1,6 (1,2–2,5) и 2,3 (1,6–3,5) мл/м2, в правой ПА, 1,7 (1,2–2,3) и 2,4 (1,7–3,3) мл/м2, в левой ПА; для общего ПК: SIk 2,5 (2,2–4,2) и 4,0 (2,9–5,7) мл/м2, в правой ПА, 2,7 (2,2–3,7) и 3,7 (3,1–5,1) мл/м22, в левой ПА соответственно. Снижение СКФ в течение 5 лет наблюдения было более выраженным у больных с ФП, чем у пациентов с СР – на 29,2 (17,1–39,4) и 9,8 (3,5–13,8) мл/мин/1,73 м2 соответственно. Таким образом, ФП сопровождается большим нарушением почечной гемодинамики, снижением клубочковой фильтрации и большей частотой развития микроальбуминурии, а также большей скоростью прогрессирования дисфункции почек у больных с ХСН, чем СР.

The aim of the study was to estimate relationship between atrial fibrillation (AF) and renal function, microalbuminuria, renal blood flow (RBF) in CHF patients I–IV NYHA functional class. Patients: n = 118, median (interquartile range): age 62,0 (54,0–67,0) years; left ventricular ejection fraction (LVEF, Simpson) 28,0% (23,0–34,0)%, 89,0% males) without primary diseases of kidney, urinoexcretory ways, endocrine system or oncological diseases. AF was found in 38% (95%CI 28,4–47,6) of patients. Frequency of appearance of shortness of breath, fatigue, palpitation were similar in the AF and sinus rhythm (SR) patients, but oedema was more severe in AF patient. There was no difference in the NYHA class, gender, age, LVEF between the AF and SR patients. Glomerular filtration rate (GFR, MDRD) was lower [98,5 (95,2–103,9) vs. 102,7 (97,8–108,2) ml/min/1,73 m2] and urine albumin-creatinine ratio (ACR, immunoenzymatic assay-Jaffe method) was higher [32,7 (9,7–46,3) vs 9,3 (1,8–33,3) mg/g] in the AF compared to the SR patients. Basal and general renal blood flow (RBF) was decreased in the AF patients. The follow-up period was 22 (6–105) months. The total mortality rate was 53,5%. AF did not affect the mortality. GFR decreased during 61 months. Its decline was more severe in the AF vs SR patients – 29,2 (17,1–39,4) vs 9,8 (3,5–13,8) ml/min/1,73 m2. So, atrial fibrillation in CHF patients is associated with decrease in renal blood flow and glomerular filtration rate as well as with elevation of urinary albumin excretion compared to patients with sinus rhythm.

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The authors declare that there are no conflicts of interest present.