nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное общество10.28996/2618-9801-2025-3-269-280nid-3875Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESФункциональное состояние почек у пациентов с острой декомпенсацией сердечной недостаточности: результаты годового амбулаторного наблюденияFunctional kidney state in patients with decompensated heart failure: annual outpatient follow-up resultshttps://orcid.org/0000-0002-5873-1768КобалаваЖ. Д.KobalavaZh. D.

Кобалава Жанна Давидовна – д-р мед. наук, профессор, заведующая кафедрой внутренних болезней с курсом кардиологии и функциональной диагностики им. В.С. Моисеева, член-корр. РАН.

117198, Москва, Миклухо-Маклая ул., д. 6

Zhanna D. Kobalava.

6, Miklukho-Maklaya str., Moscow, 117198

kobalava-zhd@rudn.ruhttps://orcid.org/0009-0004-2428-608XКонтареваН. И.KontarevaN. I.

Контарева Наталья Ильинична – аспирант кафедры внутренних болезней с курсом кардиологии и функциональной диагностики им. акад. В.С. Моисеева.

117198, Москва, Миклухо-Маклая ул., д. 6

Natalia I. Kontareva.

6, Miklukho-Maklaya str., Moscow, 117198

k0ntarevanatalja@yandex.ruhttps://orcid.org/0000-0001-9255-901XХрулеваЮ. В.KhrulevaYu. V.

Хрулева Юлия Викторовна – канд. мед. наук, ассистент кафедры внутренних болезней с курсом кардиологии и функциональной диагностики им. акад. В.С. Моисеева.

117198, Москва, Миклухо-Маклая ул., д. 6

Yulia V. Khruleva.

6, Miklukho-Maklaya str., Moscow, 117198

julia-wk@mail.ruhttps://orcid.org/0009-0003-6862-0118АндриамануэриР. Т.AndriamanoheryR. T.

Андриамануэри Робинсон Тсимин – аспирант кафедры внутренних болезней с курсом кардиологии и функциональной диагностики им. акад. В.С. Моисеева.

117198, Москва, Миклухо-Маклая ул., д. 6

Robinson T. Andriamanohery.

6, Miklukho-Maklaya str., Moscow, 117198

robamhy@mail.ruhttps://orcid.org/0000-0002-6697-2393КарапетянЛ. В.KarapetyanL. V.

Карапетян Лала Вазгеновна – канд. мед. наук, доцент кафедры внутренних болезней с курсом кардиологии и функциональной диагностики им. акад. В.С. Моисеева.

117198, Москва, Миклухо-Маклая ул., д. 6

Lala V. Karapetyan.

6, Miklukho-Maklaya str., Moscow, 117198

l.karapetyan@bk.ruhttps://orcid.org/0000-0001-7370-8606ГалочкинС. А.GalochkinS. A.

Галочкин Святослав Александрович – канд. мед. наук, доцент кафедры внутренних болезней с курсом кардиологии и функциональной диагностики им. акад. В.С. Моисеева.

117198, Москва, Миклухо-Маклая ул., д. 6

Svyatoslav A. Galochkin.

6, Miklukho-Maklaya str., Moscow, 117198

galochkin_sa@pfur.ruФГАОУ ВО «Российский университет дружбы народов имени Патриса Лумумбы»Россия“Patrice Lumumba Peoples’ Friendship University of Russia”Russian Federation202504102025273269280Copyright © Кобалава Ж.Д., Контарева Н.И., Хрулева Ю.В., Андриамануэри Р.Т., Карапетян Л.В., Галочкин С.А., 20252025Кобалава Ж.Д., Контарева Н.И., Хрулева Ю.В., Андриамануэри Р.Т., Карапетян Л.В., Галочкин С.А.Kobalava Z.D., Kontareva N.I., Khruleva Y.V., Andriamanohery R.T., Karapetyan L.V., Galochkin S.A.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/3875Цель

Цель: проанализировать частоту, факторы риска развития/прогрессирования ХБП в течение года после острой декомпенсации сердечной недостаточности (ОДСН), оценить роль выявленных в период госпитализации вариантов повреждения почек в развитии комбинированных почечных, сердечно-сосудистых исходов.

Материалы и методы

Материалы и методы: включали пациентов с ОДСН. Критерии исключения: ХБП стадии 4, 5, тяжелая СН с невозможностью амбулаторного наблюдения. Комбинированная почечная конечная точка: ускоренное прогрессирование ХБП/развитие ХБП de novo/прогрессирование стадии ХБП. Комбинированная сердечно-сосудистая точка: смерть от любой причины/повторные госпитализации с ОДСН. Проводились физическое, лабораторное, инструментальное обследования.

Результаты

Результаты: включено 108 пациентов. 60% – мужчины, средний возраст 71 (61-75) лет, фракция выброса левого желудочка – 45 (35-53)%, АГ – 92%, СД – 35%, ХБП – 26%, СКФ <60 мл/мин/1,73 м2 в период госпитализации 47%.

Частота наступления комбинированного почечного исхода – 42%. Прогрессирование стадии ХБП – 29% (n=13), ХБП de novo – 46% (n=21), ускоренное прогрессирование ХБП – 49% (n=22), изолированное ускоренное прогрессирование ХБП (только снижение СКФ в пределах стадии ХБП) – 25% (n=11).

По данным логистической регрессии факторы неблагоприятного почечного исхода: ХБП в анамнезе ОР – 8,7 (95% ДИ 2,2 – 35, p=0,002), застой по VExUS (выписка) ОР – 5,5 (95%ДИ 1,5 – 20, p=0,008), доза петлевого диуретика (выписка) >40 мг/сутки ОР – 4,2 (95%ДИ 1,3 – 3, p=0,012), повышение NT-proBNP, соответствующее ОДСН (выписка) ОР – 4,2 (95%ДИ 1,2 – 15, p=0,025), мочевая кислота >360 ммоль/л (поступление) ОР – 4,1 (95%ДИ 1,4 – 2, p=0,009), доза петлевого диуретика (поступление) >80 мг/сутки ОР – 3,7 (95%ДИ 1,2 – 11, p=0,019), ОБП в период госпитализации ОР – 3,6 (95%ДИ 1,3 – 10, p=0,017), мочевина >8,3 ммоль/л (поступление) ОР – 3,1 (95%ДИ 1 – 9, p=0,037), медиана возраста ОР – 1,1 (95%ДИ 1 – 1,1, p=0,017).

Частота наступления комбинированного сердечно-сосудистого исхода 38%. Графики Каплана-Мейера достижения комбинированного сердечно-сосудистого исхода показали худшие результаты в группе ОПП/ОБП по сравнению с группами стабильного течения ХБП, отсутствия патологии почек (Log-Rank p=0,02).

Заключение

Заключение: 42% пациентов достигли комбинированной почечной конечной точки. Наиболее значимыми факторами риска были ХБП в анамнезе, степень застоя. Сердечно-сосудистые исходы встречались чаще в группе пациентов, перенесших ОПП/ОБП по сравнению с другими группами функционального состояния почек.

Objective

Objective: to analyze the frequency and risk factors for the development or progression of chronic kidney disease (CKD) during the year following acute decompensated heart failure (ADHF), to assess the role of kidney damage patterns identified during hospitalization in the development of composite renal and cardiovascular outcomes.

Materials and methods

Materials and methods: patients with ADHF and documented serum creatinine levels within the 3 months preceding hospitalization were included. Patients with CKD stage 4, 5 or advanced heart failure (HF) who were unable to undergo outpatient follow-up were included. Composite renal outcome: rapid progression, de novo development or stage progression of CKD. Composite cardiovascular outcome: all-cause mortality or rehospitalizations for ADHF. Physical, laboratory, and instrumental examinations were performed.

Results

Results: A total of 108 patients were enrolled. Of these, 60% were men; mean age 71 (61-75) years, left ventricle ejection fraction was 45% (35-53%). The prevalence of comorbities was: arterial hypertension (AH) 92%, diabetes mellitus (DM) 35%, and CKD 26%. During hospitalization 47% had an estimated GFR < 60 ml/min/1.73 m2.

The incidence of composite renal outcomes was 42%. Specifically, stage progression of CKD in 29% (n=13), de novo CKD in 46% (n=21), rapid progression in 49% (n=22), and isolated rapid progression (decline in GFR within the CKD stage) in 25% (n=11).

Logistic regression identified the following independent risk factors for adverse renal outcomes: prior history of CKD (HR– 8.7, 95% CI 2.2 – 35, p=0.002), venous congestion discharge (VExUS) (HR 5.5, 95% CI 1.5 – 20, p=0.008), loop diuretic dose >40 mg/day at discharge (HR – 4.2, 95% CI 1.3 – 13, p=0.012), elevated NT-proBNP at discharge (HR 4.2, 95% CI 1.2 – 15, p=0.025), serum uric acid >360 mmol/l on admission (HR – 4.1, 95% CI 1.4 – 12, p=0.009), loop diuretic dose >80 mg/day on admission (HR 3.7, 95% CI 1.2 – 11, p=0.019), acute kidney disease (AKD) during hospitalization (HR – 3.6, 95% CI 1.3 – 10, p=0.017), serum urea >8.3 mmol/l on admission (HR – 3.1, 95% CI 1 – 9, p=0.037), and higher median of age (HR 1.1, 95% CI 1 – 1.1, p=0.017).

The incidence of composite cardiovascular outcomes was 38%. Kaplan-Meyer curves demonstrated poorer cardiovascular outcomes in the AKI/AKD group compared with groups with patients with stable CKD or no kidney pathology (log-rank p=0.02).

Conclusion

Conclusion: composite renal outcome events occurred in 42% of participants. The most significant risk factors were a history of CKD and HF-related congestion. Cardiovascular outcomes were more frequent in patients with AKI/AKD than in those with stable CKD or no kidney disease.

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