P0193MEASUREMENTS OF SERUM CREATININE AND EGFR IN PATIENTS WITH CHRONIC CARDIORENAL SYNDROME TYPE 2 ARE INSUFFICIENT TO ASSESS RENAL RESPONSES TO RESYNCHRONIZATION THERAPY DURING A TREE-MONTH FOLLOW-UP

Abstract

Abstract Background and Aims Chronic cardiorenal sydrome type 2 (CRS-T2) has a complex pathophysiology. Treatment and evaluation of the clinical effects of CRS-T2 therapy is difficult in clinical practice. The study’s aim was to non-invasively assess renal function using biomarkers associated with nephron injury sites in patients with CRS-T2 following cardiac resynchronization therapy (CRT). Method The study included patients with CRS-T2 and heart failure in NYHA classes II-IV, in whom CRT devices had been implanted. Before cardiac resynchronization therapy and after 3 months, patients’ renal function was assessed using biomarkers measured in single urine and blood samples. Test results were correlated with cardiovascular fitness assessments. Results CRT was implanted in 56 (n = 17; 30.4% ♀) patients with a mean age of 66 ± 10 years with CRS-T2 in the course of coronary artery disease (n = 38) or dilated cardiomyopathy (n = 18) with eGFRCKD-EPI = 68.55 ± 20.34 ml / min / 1.73m2. The three-month follow-up was continued in 33 (61.11%) patients. Three months after implantation CRT, the responders group cardiovascular endurance improved by at least on NYHA class; showed a significant decrease in NT-pro BNP (n = 24; 72.72%; p = 0.004), a significant (p < 0.05) decrease in serum prostaglandin D2 synthase (sPGD2S) and albuminuria (uACR) concentrations (Figure 1 a), and increases in hematocrit (HCT), erythrocyte count (RBC) and hemoglobin (Hb). The urine samples of the non-responders group following CRT, showed significant (p <0.05) increases in lipocalin concentrations associated with neutrophil gelatinase (uNGAL), and a decrease in cystatin C (uCysC) concentrations (Figure 1 b). There were no significant changes in the concentration of serum creatinine (sCr), eGFRCKD-EPI, serum cystatin C or uromodulin in urine and serum; and urinary kidney injury molecule-1 (uKIM-1) was found in the urine of both responding and nonresponding groups (p> 0.05). Conclusion The sCR and eGFR CKD-EPI assessment should not be used to assess renal function in patients with type 2 chronic cardiac renal syndrome who have undergone CRT implantation. Renal function biomarkers that account for the pathophysiology of nephron injury and correlated with myocardial function: sPGD2S, uACR, uCysC, uNGAL. Also, increased HCT, RBC, and Hb are characteristic in responders.