CARDIORENAL INTERACTION IN DECOMPENSATED CHRONIC HEART FAILURE

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

Chronic kidney disease: definition, classification, diagnostics, and treatment

Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD). At the same time, CKD is an independent risk factor of CVD and mortality. CVD and CKD share common conventional risk factors (such as arterial hypertension, diabetes mellitus, obesity, and dyslipidemia). The combination of CVD and CKD is associated with such non-conventional renal risk factors as hyperhydratation, anemia, phosphorus and calcium metabolism disturbances,systemic inflammation,  and hypercoagulation, which can also influence the development and pathogenesis of CVD. High prevalence of renal dysfunction and adverse prognostic role of reduced glomerular filtration rate (GFR) and albuminuria justified the development of the universal therapeutic strategy for CKD patients. The latest version of these recommendations was published in 2013, as a part of the KDIGO (Kidney Disease Improving Global Outcomes) initiative. The latest KDIGO recommendations classify CKD not only by GFR categories, but also by albuminuria levels, which provides an opportunity to stratify patients by their complication risk. The new classification is based on the evidence demonstrating that the risks of total and cardiovascular mortality, acute renal damage, and CKD progression substantially differ by the levels of urinary albumin excretion, regardless of GFR values. The need for early diagnostics of renal and cardiovascular dysfunction, in order to stratify risk levels and define the therapeutic strategy and tactics, is also reflected by the updates of the national and international recommendations on arterial hypertension, atherosclerosis, and cardiovascular prevention

URINE NGAL PREDICTS POOR SHORT-TIME OUTCOMES IN PATIENTS WITH ACUTE KIDNEY INJURY AND DECOMPENSATED HEART FAILURE

50th European-Renal-Association - European-Dialysis-and-Transplant-Association Congress. Istanbul, TURKEY, MAY 18-21 201