Cardio-renal syndrome type 2: Therapeutic and prognostic impact

Abstract

Chronic heart failure (CHF) is a serious disease, and its prevalence is steadily increasing. Among patients with CHF, 30–60% have chronic renal impairment, defining cardio-renal syndrome (CRS) type 2. Patients with CRS type 2 have a higher morbidity and mortality and have a therapeutic problem. The objective of our study was to evaluate the therapeutic and prognostic impact of CKD in CHF patients. This was a retrospective study involving 70 patients with CHF (LVEF ≤ 50%) divided into two groups: – type 2 cardio-renal syndrome (SCR) group: patients with creatinine clearance < 60 ml/min; – a control group: patients with creatinine clearance ≥ 60 ml/min. Patients with CRS type 2 were older (66 years versus 54 years, P = 0.001). The risk of developing CRS type 2 was correlated with the female genus and the presence of high blood pressure. The presence of a CRS type 2 worsens the clinical picture of the CHF, as dyspnea stage IV was more severe (68% versus 38%, P = 0.03) and blood pressure was higher for Systolic (141 versus 122, P = 0.002) and diastolic (86 versus 75 P = 0.01) in the CRS type 2 group. Biologically, patients with CRS type 2 had more anemia with lower average hemoglobin (12.9 versus 13.9, P = 0.01). Therapeutically, nitrates were used more often in patients with CRS type 2 (20% versus 5%, P = 0.05). As for the evolution of our patients, the occurrence of outbreaks of heart failure and mortality were significantly higher in the SCR group type 2. The occurrence of a SCR worsens the initial picture of heart failure, exposes it to more cardiovascular events, and aggravates the patient's prognosis. Management must be early and prevention of cardiovascular risk factors remains the most effective way to limit the incidence of CHF and CRS.