PROGNOSTIC VALUE OF KIDNEY FUNCTION PARAMETERS IN PATIENTS WITH CHRONIC HEART FAILURE AND LEFT VENTRICULAR REDUCED EJECTION FRACTION

Abstract

Chronic heart failure (CHF) is a complex clinical syndrome characterized by progressive course, unsatisfactory quality of life, poor prognosis and high incidence of concomitant renal dysfunction (RD). The aim of our work was to study the prognostic value of a number of renal function indicators in patients with CHF and a reduced left ventricular ejection fraction (LVEF). Materials and methods. 134 patients with stable CHF and reduced (<40 %) LVEF, II-IVNYHA class were examined. Patients were divided into two groups according to the level of GFR: the first group of GFR<60 ml/min./1.73 m², the second – GFR≥60 ml/min./1.73 m². The average follow-up period was 13.4 months, the maximum was 27.5 months. Results. In 53 patients RD was detected (glomerular filtration rate was ˂60 ml/min/1.73 m²), which was 39.5 %. Patients of both groups did not differ in their main hemodynamic parameters, left ventricular ejection fraction, and pharmacotherapy structure, but were older in age and heavier clinically. After the analysis of survival curves of patients depending on GFR, a group of patients with RD had a significantly worse survival prognosis compared to a group without RD. After adjusting the groups by age and NYHA class, the indicated difference was maintained. The subjects were divided according to median levels: blood urea nitrogen, blood urea nitrogen / creatinine ratio, microalbuminuria, albumin / creatinine ratio in urine. The long-term survival of the formed groups was analyzed. The level of blood urea nitrogen did not significantly influence the prognosis of patients with CHF and reduced LVEF. At the same time, when the groups were divided, depending on the median value of the blood urea nitrogen / creatinine ratio, there was a significantly higher risk of fatal outcome in the group with lower indices. The level of MAU did not significantly affect the survival of patients. In addition, a comparison of the survival of patients with higher and lower values of the albumin / creatinine ratio in the urine revealed a significantly higher risk of death in patients with higher values. Conclusions: 1. The presence of RD (GFR˂60 ml/min/1.73 m²) is observed in 39.5 % of patients with CHF and reduced LVEF and is associated with their worst long-term survival. 2. The BUN and MAU do not have sufficient predictive information about the forecast of long-term survival of the above category of patients. 3. At the same time, the values of the BUN/ Сreatinine ratio ˂24.5 and the ACR ˃12.7 indicate patients with CHF who have a higher long-term risk of death.