Type 2 Cardiorenal Syndrome: Prevalence and Correlates in Nigerian Heart Failure Patients.

Abstract

Background: Type 2 cardiorenal syndrome (Type 2 CRS) describes a relationship in which chronic congestive heart failure causes a progressive and permanent chronic kidney disease. Heart failure (HF) and chronic kidney disease (CKD) share similar cardiovascular risk factors and have a bi-directional relationship. A comprehensive approach including early screening of HF patients for CKD as well as management involving the nephrologist and cardiologist will most definitely reduce morbidity and mortality. The aim of this study was to determine the prevalence of and correlates for Type 2 CRS among HF patients in JUTH, Jos-Nigeria.

Methodology: A hospital-based cross-sectional descriptive study carried out in JUTH involving 120 patients with chronic HF recruited consecutively. History, physical examination and laboratory investigations including urinalysis using albustix were performed on all subjects. CKD was determined using estimated glomerular function rate (eGFR) and persistent albuminuria. The data were analyzed using Epi Info (CDC, Atlanta GA) and p-values <0.05 were considered statistically significant.

Results: The mean age of the participants was 52.00 ± 11.44 years, majority of whom were females consisting of 58.3%. The prevalence of CRS was 37.5%. Majoity (66.7%) of the patients had mild CRS, while 26.7% had moderate CRS, and only 6.7% had the severe CRS. The predictors of CRS were diabetes (OR=6.230; CI=2.094-19.093), New York heart Association (NYHA) grading I (OR=0.017; CI=0.002-0.142) and II (OR=0.089; CI=0.016-0.483), raised jugular venous pressure (JVP) (OR=7.099; CI=2.671-18.865), loud pulmonary component of the second heart sound (P2) (OR=3.769; CI=1.726-8.232), systolic dysfunction (EF<45%) (OR=3.316; CI=1.487-7.395), anaemia (OR=5.091; CI=1.657-15.640), albuminuria (OR:0.014, CI=0.004-0.052), rural/suburban dwelling (OR=2.875; CI=1.335-6.192) and increased cardiothoracic ratio (CTR) (OR=3.237; CI=1.019-10.278).

Conclusion: The frequency of Type 2 CRS among CHF patients in JUTH was high. The predictors of chronic CRS include diabetes mellitus, NYHA grade, raised JVP, loud P2, systolic dysfunction, anaemia, albuminuria, rural/suburban dwelling and increased CTR. These findings highlight the urgent need to incorporate screening for CKD among stable heart failure patients at regular intervals, and early referral to the nephrologist to prevent further deterioration to ESRD.