Predictors of renal dysfunction in patients with chronic heart failure and reduced left ventricular ejection fraction

Abstract

The aim — to elucidate the predictors of renal dysfunсtion (RD) in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LVEF). Materials and methods. 134 patients were examined with stable CHF, II — IV NYHA functional class (FC), and LVEF < 40 %. Median age was 59.5 [54; 68] years. All patients underwent general clinical examination. Glomerular filtration rate was calculated. The levels of interleukin­6, insulin, NTproBNP, uric acid, blood urea nitrogen, levels of microalbuminuria were determined. Ultrasound diagnosis of the vasodilating function of the endothelium of the brachial artery was performed using a test with reactive hyperemia. The patients were treated according to the current guidelines of the Association of Cardiologists of Ukraine on the diagnosis and treatment of chronic heart failure. Results and discussion. RD was detected in 39.5 % of the patients examined. Older patients, women, patients with coronary heart disease (CHD), arterial hypertension (AH), diabetes mellitus, anemia, and also III — IV NYHA class have a greater chance of having RD. The presence of myocardial infarction (MI), atrial fibrillation (AF), smoking in the anamnesis did not reveal significance in calculating the odds ratio. None of the major hemodynamic and echocardiographic parameters was a predictor of PD. Among the laboratory indices, independent predictors of RD were detected levels of blood urea nitrogen, uric acid, and citrulline levels.The results obtained indicate the priority role of neuro­humoral activation, inflammation and oxidative stress in the formation of RD. Conclusions. The independent laboratory predictors of RD in 39.5 % of the patients with CHF and a reduced LVEF are the levels of blood urea nitrogen, uric acid and citrulline in the plasma. Its risk increases with age, NYHA class, the duration of CHF, and in the presence of such co­morbidities as AH, CHD, diabetes mellitus, anemia. The presence of RD is not associated with MI in anamnesis or the presence of AF, parameters of central hemodynamics, parameters of LV structural­functional states, level of microalbuminuria, ratio of albumin/creatinine, level of glucose, insulin, interleukin­6 and NTproBNP in plasma.