The involvement of kidneys in chronic heart failure patients with liver steatosis

Abstract

Recently, the internist-practitioner does not routinely assess glomerular filtration rate (GFR) in there no risk factors for chronic kidney disease (CKD). However, recent data shows that in non-alcoholic fatty liver disease (NAFLD) it is necessary to assess GFR even without any classic risk factors for CKD. Early awareness of kidney damage in chronic heart failure patients (CHF) and NAFLD might help to select those requiring further investigation and treatment, taking into account comorbidity. Aim. To assess functional condition of kidneys in CHF patients with liver steatosis. Material and methods. Totally, 77 CHF patients included. All patients had confirmed CHF diagnosis by N-terminal Brain pro-natriuretic peptide assay. The severity of clinical condition in CHF was assessed, functional status of patient. All patients underwent clinical and biochemical blood sampling, electrocardiography, ultrasound liver imaging. The heart chambers sizes were assessed, walls thickness by echocardiography. All patients had the GFR by CKD-EPI calculated, as the Fatty Liver Index (FLI), NAFLD Fibrosis Score (NFS). Results. More than a half (66%) of patients with CHF had C2 stage of CKD, 6% — С1, 12% — С3а, 9% — С3б, 4% — С4 stage of CKD. Patients with С5 were absent. Mean GFR was 65,4±14,4 ml/min/1,73 m2. In statistical analysis it was revealed that while there is an increase of SCAHF points, there is parallel increase of CKD stage (p=0,0027). Higher glucose level, higher the stage of CKD (p=0,0022). It was found, that while there is and increase of CKD, right atrium size also increases (p=0,044). With more severe renal damage in CHF, higher the level of PIIINP myocardium fibrosis marker (p=0,047). According to FLI, in 40% of patients there is high chance for liver steatosis, in 34% of patients the data on steatosis was absent, in 26% was intermediate. According to NFS, 26% patients had high probability of liver fibrosis, 9% — did not have, 65% were in a “grey zone”. In analysis of relations there was found that while increasing NFS, GFR does decrease, and CKD stage increases (p=0,049). Conclusion. Patients with NAFLD and CHF do need GFR assessment. Early finding of renal involvement in CHF with NAFLD would help to select patients for further investigation and therapy prescription, taking into account comorbidity.