Decrease of kidney function and prognosis in patients with chronic heart failure

The aim of this study was to investigate the impact of chronic kidney disease (CKD) on prognosis in patients with chronic heart failure (CHF). Methods: 251 patients with chronic heart failure (133 M, 118 F, age 56,4 ± 11,2 years) were studied; 59 (23,5%) patients had arterial hypertension, 29 (11,5%) had Ischaemic Heart Disease (IHD) and 163 (65,0%) had IHD and arterial hypertension. Most patients (227 or 90,4%) had I-II NYHA class of CHF. Glomerular filtration rate (GFR) was estimated by the Modification of Diet in Renal Disease (MDRD) Study equation and chronic kidney disease was determined according to NKF K/DOQI, Guidelines, 2002. Follow-up period was 60 months. The death incidence of any cause and the re-hospitalization rate were estimated. Results. In 88 (35,1%) patients GFR was below 60 ml/min/1,73 m². The mortality rate for all causes was 41 (16,3%).The mortality rate in these patients was higher than in those with normal GFR. The patients with decreased GFR were re-hospitalized more frequently than those with preserved renal function. CKD was an independent mortality risk factor in patients with CHF (Hazard ratio: 1,6). Conclusions. It is founded that decreased renal function (GFR < 60 ml/min/1,73 m²) increases the mortality risk in patients with CHF. Renal dysfunction is an independent predictor of re-hospitalization for CHF patients.

хроническая болезнь почек, хроническая сердечная недостаточность, прогностическое значение

1. Бикбов Б.Т., Томилина Н.А. Факторы риска смерти больных, впервые начинающих лечение гемодиализом (по данным Регистра Российского диализного общества). Нефрология и диализ 2008; 12 (1): 35-43.

2. Волков М.М., Дегтерева О.А., Шевякова Е.В. Факторы, связанные с кальцинацией клапанного аппарата сердца у пациентов на хроническом гемодиализе. Нефрология 2007; 11 (3): 57-63.

3. Национальные рекомендации ВНОК и ОССН по диагностике и лечению ХСН (второй пересмотр). Сердечная недостаточность 2007; 8 (1): 4-41.

4. Российские национальные рекомендации по диагностике и лечению анемии при хронической болезни почек. Анемия 2006; 3: 3-18.

5. Смирнов А.В., Добронравов В.А., Каюков И.Г. Кардио-ренальный континуум: патогенетические основы превентивной нефрологии. Нефрология 2005; 9 (3): 7-15.

6. Шутов А.М., Курзина Е.В., Серов В.А., Ивашкина Т.Н. Митральная регургитация у больных с хронической сердечной недостаточностью ассоциирована со снижением функционального состояния почек. Нефрология 2008; 12 (1): 19-23.

7. Шутов А.М., Машина Т.В., Мардер Н.Я. и др. Хроническая сердечная недостаточность у больных с хронической болезнью почек. Нефрология и диализ 2005; 7 (2): 140-144.

8. Allessie M., Ausma J., Schotten U. Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc Res 2002; 54 (2): 230-234.

9. Amann K., Ritz E. Cardiovascular abnormalities in ageing and in uraemia - only analogy or shared pathomechanisms? Nephrol Dial Transplant 1998; 13 (Suppl 7): 6-11.

10. Arnold J.M.O., Liu P., Demers C. et al. Canadian Cardiovascular society consensus conference recommendations on heart failure 2006: Diagnosis and management. Can J Cardiol 2006; 22 (1): 23-45.

11. Blanc B., Finch C.A., Hallberg L. et al. Nutritional anaemias. Report of a WHO Scientific Group. WHO Tech Rep Ser 1968; 405: 1-40.

12. Brewster U.C., Setaro J.F., Perazella M.A. The renin-angiotensin-aldosterone system: Cardiorenal effects and implications for renal and cardiovascular disease states. Am J Med Sci 2003; 326: 15-24.

13. Caramelo C., Justo S., Gil P. Anemia in heart failure: pathophysiology, pathogenesis, treatment, and incognitae. Rev Esp Cardiol 2007; 60 (8): 848-860.

14. Cohn J.N., Tognoni G. A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 2001; 345: 1667-1675.

15. Elsayed E.F., Tighiouart H., Griffith J. et al. Cardiovascular Disease and Subsequent Kidney Disease. Arch Intern Med 2007; 167: 1130-1136.

16. Genovesi S., Pogliani D., Faini A. et al. Prevalence of atrial fibrillation and associated factors in a population of long-term hemodialysis patients. Am J Kidney Dis 2005; 46 (5): 897-902.

17. 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 (13): 1296-1305.

18. Go A.S., Yang J., Ackerson L.M. et al. Hemoglobin level, chronic kidney disease, and the risks of death and hospitalization in adults with chronic heart failure: the Anemia in Chronic Heart Failure: Outcomes and Resource Utilization (ANCHOR) Study. Circulation 2006; 113 (23): 2713-2723.

19. Hillege H.L., Girbes A.R., De Cam P.J. et al. Renal function, neurohormonal activation and survival in patients with chronic heart failure. Circulation 2000; 102 (2): 203-210.

20. Ix J.H., Shlipak M.G., Katz R. et al. Kidney function and aortic valve and mitral annular calcification in the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Kidney Dis 2007; 50 (3): 412-420.

21. Kannel W. Epidemiology and prevention of cardiac failure: Framingham Study insights. Eur Heart J 1987; 8: Suppl F: 23-29.

22. Komukai K., Ogawa T., Yagi H. et al. Decreased Renal Function as an Independent Predictor of Re-Hospitalization for Congestive Heart Failure. Circ J 2008; 72: 1152-1157.

23. Kosiborod M., Curtis J.P., Wang Y. et al. Anemia and outcomes in patients with heart failure: a study from the National Heart Care Project. Arch Intern Med 2005; 165 (19): 2237-2244.

24. Kotanko P. Cause and consequences of sympathetic hyperactivity in chronic kidney disease. Blood Purif 2006; 24 (1): 95-99.

25. Lee Y.A., Liang C.S., Lee M.A., Lindpaintner K. Local stress, not systemic factors, regulate gene expression of the cardiac renin-angiotensin system in vivo: a comprehensive study of all its components in the dog. Proc Natl Acad Sci USA 1996; 93 (20): 11035-11040.

26. Levey A.S., Coresh J., Balk E. et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003; 139 (2): 137-147.

27. Liao L., Allen L.A., Whellan D.J. Economic burden of heart failure in the elderly. Pharmacoeconomics 2008; 26 (6): 447-462.

28. Masoudi F.A., Rathore S.S., Wang Y. et al. National patterns of use and effectiveness of angiotensin-converting enzyme inhibitors in older patients with heart failure and left ventricular systolic dysfunction. Circulation 2004; 110 (6): 724-731.

29. McClellan W.M., Langston R.D., Presley R. Medicare patients with cardiovascular disease have a high prevalence of chronic kidney disease and a high rate of progression to end-stage renal disease. J Am Soc Nephrol 2004; 15 (7): 1912-1919.

30. Mendelssohn D.C., Toffelmire E.B., Levin A. Attitudes of Canadian nephrologists toward multidisciplinary team-based CKD clinic care. Am J Kidney Dis 2006; 47: 277-284.

31. Petretta M., Scopacasa F., Fontanella L. et al. Prognostic value of reduced kidney function and anemia in patients with chronic heart failure. J Cardiovasc Med (Hagerstown) 2007; 8 (11): 909-916.

32. Schiller N.B., Shan P.M., Crawford M. et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr 1989; 2 (5): 358-367.

33. Schneider C., Malisius R., Krause K. et al. Strain rate imaging for functional quantification of the left atrium: atrial deformation predicts the maintenance of sinus rhythm after catheter ablation of atrial fibrillation. Eur Heart J 2008; 29 (11): 1397-1409.

34. Silverberg D.S., Wexler D., Iaina A., Schwartz D. The interaction between heart failure and other heart diseases, renal failure, and anemia. Semin Nephrol 2006; 26 (4): 296-306.

35. Stam F., van Guldener C., Becker A. et al. Endothelial dysfunction contributes to renal function-associated cardiovascular mortality in a population with mild renal insufficiency: the Hoorn study. J Am Soc Nephrol 2006; 17 (2): 537-545.

36. The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 1991; 325: 293-302.

37. Titler M.G., Jensen G.A., Dochterman J.M. et al. Cost of hospital care for older adults with heart failure: medical, pharmaceutical, and nursing costs. Health Serv Res 2008; 43 (2): 635-655.

38. Tsang T.S., Gersh B.J., Appleton C.P. et al. Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women. J Am Coll Cardiol 2002; 40 (9): 1636-1644.

39. Weiner D.E., Tighiouart H., Stark P.C. et al. Kidney disease as a risk factor for recurrent cardiovascular disease and mortality. Am J Kidney Dis 2004; 44 (2): 198-206.

40. Yusuf S., Pfeffer M.A., Swedberg K. et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM Preserved Trial. Lancet 2003; 362: 777-781.

41. Zakai N.A., Katz R., Hirsch C. et al. A Prospective Study of Anemia Status, Hemoglobin Concentration, and Mortality in an Elderly Cohort. The Cardiovascular Health Study. Arch Intern Med 2005; 165: 2214-2220.