EVALUATION OF BIOCHEMICAL PARAMETERS OF BLOOD AND RENAL DYSFUNCTION IN PATIENTS WITH CHRONIC HEART FAILURE
DOI:
https://doi.org/10.11603/mcch.2410-681X.2020.v.i3.11531Keywords:
chronic heart failure, kidney dysfunction, creatinine; glomerular filtration rate, fermentationAbstract
Introduction. Renal dysfunction is the leading cause of significant comorbidities associated with an unfavorable clinical prognosis. It should be noted that chronic heart failure dramatically impairs the quality of life of patients and increases the risk of mortality. The mortality rate during the year is 15–50 %. The main factor in the deterioration of renal function is a decrease in cardiac output and venous stasis. Decreased cardiac output decreases renal perfusion and thus glomerular filtration rate. Venous stasis causes an increase in pressure in the external arterioles and capillaries of the glomeruli.
The aim of the study – to learn the kidney dysfunction indices in patients with chronic heart failure (CHF).
Research Methods. 96 patients with postinfarction cardiosclerosis complicated by CHF at the age of 40–60 years were examined. Patients were divided into two groups by functional class (FC) of CHF according to the New York Heart Association (NYHA). The creatinine level was determined for all patients, and the glomerular filtration rate (GFR) was calculated using the formula MDRD (Modification of Diet in Renal Disease Study). Determination of enzymes in urine – alanine transferase (ALT), aspartate transferase (AST), alkaline phosphotase (ALK phos), cholinesterase by spectrophotometric method.
Results and Discussion. GFR < 60 ml/min/1,73m2 was marked in 33.3 % of patients with II FC CHF and 66.7 % of patients with III FC CHF. The study of fermentation indices in patients with CHF depending on the functional state of the kidneys revealed that in patients with GFR <60 ml/min/1,73m2, among which the patients with III FC CHF were 66.7 %, reliably high fermentation indices were noted. At the same time, level of ALT was 39 % (p<0.01) and 35 % (p<0.001) higher in comparison with patients without kidney function impairment.
Conclusions. In CHF patients subclinical renal dysfunction has been observed in process of progression of the disease which is characterized by reduction of GFR, increase of residual nitrogen level and fermentation. Urinary enzyme level determination in patients with CHF can be considered as a diagnostic approach for early diagnosis of renal dysfunction.
References
Engelfriet, P.M., Hoogenveen, R.T., & Boshuizen, H.C. (2011). To die with of from heart failure: a difference that counts: is heart failure underrepresented in national mortality statistics? Eur. J. Heart Fail., (13), 37-38.
Miyagishima, K., Hiramitsu, S., & Kimura, H. (2009). Long term prognosis of chronic heart failure: reduced vs preserved left ventricular ejection fraction. Circulation, 73 (1), 92-99.
Arutunov, G.P. Pathophysiological processes in kidneys of patients with CHF. J. Heart Faiu, 9 (5), 234-249.
Bock, J.S., & Gottlieb, S.S. (2010). Cardiorenal syndrome: new perspectives. Circulation, 21, 2592.
Berl, T., & Henrich, W. Kidney-heart interactions: Epidemiology, pathogenesis, and treatment. Clin. J. Am. Soc. Nephrol., 1, 8-18.
Eilers, H., Liu, K.D., Gruber, A., & Niemann, C.U. (2010). Chronic kidney disease: Implications for the perioperative period. Minerva Anestesiol., 76 (9), 725-736.
Bakris, G.L., Serafidis, P.A., & Weir, M.R. ACCOMPLISH Trial Investigators. Renal outcomes with different fixed-dose combination therapies in patients with hypertension at high risk for cardiovascular events (ACCOMPLISH): a prespecified secondary analysis of randomised controlled trial. Lancet, 375, 1173-1181.
(2013). KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int., 3, 1-150.
Whaley-Connell, A.T., Vassalotti, J.A., & Collins, A.J. (2012). National Kidney Foundation’s Kidney Early Evaluation Program (KEEP) Annual Data Report 2011: Executive Summary. Am. J. Kidney Dis., 59 (3) (Suppl. 2), S1-4.
Pokhrel, N., Maharjan, N., & Dhakal, B. (2008). Cardiorenal syndrome: A literature review. Exp. Clin. Cardiol., 13 (4), 165-170.
(2008). Renal function and prediction of cardiovascular risk. Cardiovascular Therapy and Prevention, 7 (6), Appendix 3.
Plischke, M., Neuhold, S., & Kohl, M. (2013). Renal function in heart failure: a disparity between estimating function and predicting mortality risk. Eur. J. Heart Failure, 15 (7), 763-770.
Ronco, C., Chionh, C.Y., & Haapio, M. (2009). The cardiorenal syndrome. Blood Purif., 27 (1), 114-126.
Mavlyanov, I.R., Akbarova, G.P., & Khabilova, N.L. (2009). The renal tubular epithelial system in patients with rheumatoid arthritis in relation to its duration. Profilac. Medicine, 3, 14-19.
Soni, S., Fahuan, Y., & Ronco, C. (2009). Cardiorenal syndrome: biomarkers linking kidney damage with heart failure. Biomarkers Med., 3 (5), 549-560.
