Clinical characterіstics and survival of hospitalized patients with chronic heart failure and reduced left ventricular ejection fraction depending on dynamics of nitrogen-releasing kidney function during period of overcoming clinical decompensation

Abstract

The aim — to investigate the main clinical hemodynamic and laboratory characteristics in hospitalized patients with chronic heart failure (CHF), depending on the dynamics of the nitrogen‑releasing renal function during the period of overcoming decompensation and to determine the prognostic value of impaired renal function (IRF) in this category of patients.Materials and methods. The study involved 134 patients with CHF caused by ischemic heart disease or dilated cardiomyopathy, and a reduced (< 40 %) left ventricular ejection fraction, heart failure of II B according to Strazhesko — Vasilenko criteria, III — IV functional class according to the criteria of the New York Heart Association (NYHA). They were hospitalized for circulatory decompensation. The median age was 59.5 (54; 68) years. All patients underwent general clinical examination, determined the level of creatinine, urea nitrogen, uric acid, interleukin‑6, plasma citrulline, N‑terminal fragment of the brain natriuretic peptide (NTproBNP) at admission and before discharge, glomerular filtration rate (GFR) using the equation CKD‑EPI. Patients received standard treatment. The patients were divided into two groups according to the level of increase in creatinine before discharge: the first one with RFW with an increase in creatinine level ≥ 17.7 mmol/l, the second one with no RFW.Results and discussion. 110 (82 %) patients showed no RFW after overcoming clinical decompensation; in 24 (18 %) patients, the creatinine level increased by 17.7 mmol/l or more, which corresponded to a decrease in GFR і 5 ml/(min 1.73 m2). At the stage of hospitalization, patients did not differ in age, frequency of comorbid pathology, main hemodynamic parameters, potassium plasma levels, glomerular filtration rate (GFR), urea nitrogen, uric acid, NTproBNP. After attaining the stable condition, lower blood pressure levels, higher levels of blood urea nitrogen, uric acid, interleukin‑6 and citrulline were observed in patients with impaired renal function. To overcome decompensation, these individuals took longer time, almost two times higher course and daily doses of loop and potassium‑preserving diuretics. Patients with impaired renal function had a statistically significantly worse prognosis regarding long‑term survival.Conclusions. Among patients with CHF and a reduced left ventricular ejection fraction (LVEF) hospitalized for circulatory decompensation, impaired renal function during treatment occurred in 18 % of cases. At the time of discharge, patients with impaired renal function compared with patients without one showed a significantly lower level of systolic blood pressure, a longer duration of decompensation overcoming, higher average daily doses of loop and potassium‑preserving diuretics, a higher content of uric acid, urea nitrogen, interleukin ‑6 and citrulline in plasma. Patients with decompensated CHF and impaired renal function had lower survival rate compared with patients without impaired renal function.