Predictive biomarkers in elderly patients with chronic cardiorenal syndrome

Aim. The presence of chronic kidney disease (CKD) in patients with chronic heart failure (CHF) negatively affects the prognosis, while the severity of both CHF and CKD is different. This study aimed to investigate the prognostic value of biomarkers of hypoxia, myocardial stress, and inflammation in patients with the chronic cardiorenal syndrome (ССS). Materials and methods. This study includes 80 patients over 60 years old with CHF (48 F, mean age 70.7±8.7). CHF was diagnosed according to the Guidelines for the diagnosis and treatment of CHF (OSSN, RKO, 2016). CKD was diagnosed and classified according to the KDIGO guidelines (2012). Biomarkers of myocardial and kidney dysfunction and hypoxia were evaluated: N-terminal propeptide of type B natriuretic hormone (NT-proBNP), cystatin C, hypoxia-inducible factor-1α (HIF-1α), endogenous erythropoietin (EPO). To analyze the pro-inflammatory status in the blood serum, interleukin (IL)-6, IL-8, and IL-18 were studied. The follow-up period was 12 months, the primary endpoint was total mortality. Results. Biomarkers of hypoxia (EPO, HIF-1α, including those corrected for hemoglobin and hypoxia index), NT-proBNP, cystatin C, and IL-6 were significantly higher in the group of deceased patients with CHF than in survivors. CKD was diagnosed in 49 (61.3%) patients with CHF. Patients with CCS had higher levels of eEPO (including those corrected for hemoglobin), NT-proBNP, cystatin C and IL-6, which was not observed for other studied biomarkers. When performing Cox regression analysis (mathematical model χ2=30.7, р=0.0002) and multivariate decision trees (mathematical model χ2=36.8, р<0.0001) to estimate prognosis in patients with CHF, serum EPO (>16,9 mIU/ml), regardless of age, other clinical factors and biomarkers, had a significant impact on annual mortality. In CKD, erythropoietin production decreases, which is a key factor in the development of anemia, but hypoxia caused by CHF additionally stimulates the production of EPO, probably in this regard, we did not observe a low level of EPO in the examined patients with CCS. Conclusion. EPO had a prognostic advantage in a predictive model with biomarkers of myocardial and renal dysfunction, hypoxia, and inflammation, which indicates a determining role of hypoxia, and not only myocardial stress, in the prognosis of patients with CCS.

хроническая сердечная недостаточность, хроническая болезнь почек, эритропоэтин, фактор, индуцируемый гипоксией-1, интерлейкин-6, индекс гипоксии, почечный фенотип хронической сердечной недостаточности, chronic heart failure, chronic kidney disease, erythropoietin, hypoxia-1-inducible factor, interleukin-6, hypoxia index, renal phenotype of chronic heart failure

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