Cardiorenal Syndrome In Patients Research Articles

Risk factors for progressive cardiorenal syndrome in patients with chronic kidney disease: The CRIC study

Risk factors for progressive cardiorenal syndrome in patients with chronic kidney disease: The CRIC study

#1575 Cardio-renal syndrome in patients with Fabry disease on enzyme replacement therapy

Abstract Background and Aims Fabry disease (FD) is a rare X-linked lysosomal storage disorder in which mutations of the GLA gene cause a decreased or absent activity of the alpha-galactosidase A (α-Gal A) and intracellular accumulation of globotriaosylceramide and other sphingolipids [1]. FD causes a variety of symptoms, including heart and kidneys damage - cardiorenal syndrome (CRS) type 5. In patients with FD, CRS is known to increase the risk of cardiovascular events and death [2]. The aim of our study was to assess renal function and outcomes in patients with FD and CRS receiving enzyme replacement therapy (ERT). Method We performed a retrospective analysis of the medical records of 10 patients (pts) from 7 unrelated families with established diagnosis of FD and cardiac and renal involvement. Pts #1 and #3 are siblings, pt # 10 is their mother; pt #9 is mother of pt #8 (Table 1). The diagnosis was confirmed by DNA diagnostics in all plus levels of α-Gal A enzymatic activity, globotriaosylsphingosine concentrations in some patients. All the patients underwent ERT. Seven out of 10 patients received blockers of the renin-angiotensin-aldosterone system, 3 - did not receive due to contraindications. Results All 10 patients, including 3 women, had left ventricular hypertrophy - left ventricular wall thickness (LVWT) ≥ 1.2 cm. (Table 1). Average LVWT was 1.850 ± 0.097 cm. Two patients had atrial fibrillation. None of the patients had proteinuria 1 g/24 h or higher. In all еGFR was below 60 ml/min/1,73 m2: 4 patients had CKD-G3a, 4 – G3b, 1 – G4 and 1 – G5. Average еGFR was 41,111 ± 8.069 ml/min/1,73 m2 excluding hemodialysis (HD) patient. There were 4 unfavorable outcomes in our group: death occurred in 3 patients from cardiac pathology (congestive heart failure), one patient reached CKD-G5 at 25 years of age and started HD treatment. Patient on HD, brother of deceased pt #1, began receiving ERT after the start of renal replacement therapy. The death of pt #1, who had a very high Lyso-Gb3 level - 118.36 ng/ml (normal 0.05-3.0 ng/ml), appears to be related to the late diagnosis and delayed start of ERT. Conclusion Patients with FD and CRS are likely to have a high risk of cardiovascular complications, loss of kidney function and death, especially with a late start of enzyme replacement and cardio-renoprotective therapy. Early diagnosis of FD and timely initiation of treatment are important in preventing the serious complications and death.

#523 Continuous electronic urine output monitoring for the management of acute cardio-renal syndrome in patients with acute decompensated heart failure

Abstract Background and aims : Patients admitted for acute decompensated heart failure (ADHF) are at high risk for type I cardio-renal syndrome (CRS) related to venous congestion and diuretic resistance. Positive fluid balance has been associated with adverse outcomes including acute kidney injury (AKI) and mortality. In critically ill patients urine output (UO) is used both to assess deterioration of renal function as well as for management of fluid balance. We investigated the possible effect of real-time UO monitoring, fluid balance, renal outcomes and 30-day mortality of patients admitted to the cardiac intensive care unit (ICU) with ADHF. Methods We performed a case series of 50 patients admitted to the cardiac ICU from July 2021 and June 2023 with ADHF. Their standard foley catheter was connected to an electronic monitoring system (Clarity-RMS sensor kit) that continuously monitors UO in real-time. Its technology is described elsewhere (1). The UO monitoring system displays UO trends on the consoles that are updated in real-time. UO trends were utilized to guide an individualized approach for the pharmacologic management of each patient, based on blood pressure, hourly UO and total fluid balance. Daily and accumulated fluid balance was registered at up to 72 hours following admission. Patient outcomes included change in fluid balance, incidence of AKI and 30-day mortality. The case series group was than compared to a historical group of 50 matched controlled patients admitted between 2019-2020. Patients were matched according to cause of admission, age and glomerular filtration rate. Results In the study cohort the median age was 71 ± 12 years, and 36 (72%) were men. In the historical cohort the median age was 71 ± 13 years, and 36 (72%) were men. Patients in the electronic urinary monitoring cohort demonstrated significantly more negative daily and cumulative fluid balance as compared to the historical cohort, (P < 0.001 for all, Fig. 1). Incidence of AKI and the combined endpoint of AKI and 30-day mortality was significantly lower in the electronic UO monitoring cohort (24% vs. 46%, p = 0.0197 and 40% vs 78%, P < 0.0001 respectively). These changes were more prominent in the subgroup of patients with chronic kidney disease (Fig. 2). Conclusion We demonstrated that real time monitoring of UO was associated with better prevention of fluid overload and the management of type I CRS in patients with ADHF. Further studies on larger populations are required to validate the potential utility of UO trending in the management of critically ill patients with ADHF.

#373 Risk factors for progressive cardiorenal syndrome in patients with chronic kidney disease: the CRIC study

Abstract Background and Aims Cardiorenal syndrome (CRS) is associated with poor outcomes. However, risk factors for progressive CRS are not well studied in patients with chronic kidney disease (CKD). We studied the incidence and risk factors for progressive CRS in a cohort of CKD patients. Method 3 557 participants with CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study were included in this analysis after excluding those with heart failure (HF) at baseline visits. The mean follow-up time was 10.5 years. Progressive CRS was defined as development of both HF and renal failure (RF) (dialysis or transplant) within 12 months of each other. Cox proportional hazards models were used to examine the association of risk factors with progressive CRS. In a sensitivity analysis, risk factors for CRS type 2 (HF preceded RF during entire follow up) and CRS type 4 (RF preceded HF) were analyzed. Results The average baseline age was 59 years for those with progressive CRS and 57 years for those without. The age-adjusted incidence of progressive CRS was 4.5/1000 person-years and was 5.0/1000 person-years in Men and 5.9 in Black. The multivariable-adjusted hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) for traditional risk factors are as follow: less than high school education (1.82, 1.2-2.73), history of cardiovascular disease (CVD) (1.48, 1.03-2.12), lower educational attainment (per 1 standard deviation [SD]) in eGFR (1.83, 1.40-2.39), and higher (per 1 SD) albumin-to-creatinine ratio (ACR) (2.26, 1.78-2.86). The multivariable-adjusted HRs with corresponding 95% CIs for a one-standard deviation increase in novel risk factors are as follows: hemoglobin (0.82, 0.68-0.99), hemoglobin A1C (1.31, 1.14-1.52), log alkaline phosphatase (1.18, 1.00-1.38), and log brain natriuretic peptide (1.32, 1.10-1.57), adjusting for age, sex, race, clinic sites, and all significant traditional risk factors (education, CVD, eGFR, and ACR). In sensitivity analysis, the risk factor associated with both CRS type 2 and 4 were kidney dysfunction, albuminuria, and mineral bone disorder (higher alkaline phosphatase and FGF23), inflammation (TNF-α), and fibrotic factor (GDF-15), while diabetes, CVD, systolic blood pressure, waist circumference, anemia, HbA1c, and volume overload were more strongly associated with CRS type 2 compared to CRS type 4. Conclusion This study indicates that education level, history of CVD, kidney dysfunction, albuminuria, mineral bone disorder, diabetes control, anemia, volume overload, inflammation, and fibrotic factors are associated with progressive CRS. Many of these risk factors are modifiable. Further studies are warranted to assess the benefits of specific interventions to improve CRS outcomes.

Using continuous electronic urine output monitoring for the management of acute cardio-renal syndrome in patients with acute decompensated heart failure

Abstract Funding Acknowledgements None. Background Patients admitted for acute decompensated heart failure (ADHF) are at high risk for type I cardio-renal syndrome (CRS) related to venous congestion and diuretic resistance. Positive fluid balance has been associated with adverse outcomes including acute kidney injury (AKI) and mortality. In critically ill patients urine output (UO) is used both to assess deterioration of renal function as well as for management of fluid balance .We investigated the possible effect of real-time UO monitoring, fluid balance, renal outcomes and 30-day mortality of patients admitted to the cardiac intensive care unit (ICU) with ADHF. Methods We performed a case series of 50 patients admitted to the cardiac ICU from July 2021 and June 2023 with ADHF. Their standard foley catheter was connected to an electronic monitoring system that continuously monitors UO in real-time. Its technology is described elsewhere (1). The UO monitoring system displays UO trends on the consoles that are updated in real-time. UO trends were utilized to guide an individualized approach for the pharmacologic management of each patient, based on blood pressure, hourly UO and total fluid balance. Daily and accumulated fluid balance was registered at up to 72 hours following admission. Patient outcomes included change in fluid balance, incidence of AKI and 30-day mortality. The case series group was than compared to a historical group of 50 matched controlled patients admitted between 2019-2020. Patients were matched according to cause of admission, age and glomerular filtration rate. Results In the study cohort the median age was 71±12 years, and 36 (72%) were men. In the historical cohort the median age was 71±13 years, and 36 (72%) were men. Patients in the electronic urinary monitoring cohort demonstrated significantly more negative daily and cumulative fluid balance as compared to the historical cohort, (P<0.001 for all, Figure 1). Incidence of AKI and the combined endpoint of AKI and 30-day mortality was significantly lower in the electronic UO monitoring cohort (24% vs. 46%, p=0.0197 and 40% vs 78%, P<0.0001 respectively). These changes were more prominent in the subgroup of patients with chronic kidney disease (Figure 2). Conclusion We demonstrated that real time monitoring of UO was associated with better prevention of fluid overload and the management of type I CRS in patients with ADHF. Further studies on larger populations are required to validate the potential utility of UO trending in the management of critically ill patients with ADHF.Fluid balance renal senseAKI and 30-day mortality

Galectin-3 as a Biomarker to Predict Cardiorenal Syndrome in Patients with Acute Heart Failure.

Galectin-3 affects cardiac tissue inflammation as an inflammatory mediator. The development of cardiorenal syndrome in heart failure patients is associated with a poor prognosis. This study aims to investigate whether serum galectin-3 levels can be used as a biomarker to predict cardiorenal syndrome in heart failure patients with reduced left ventricular ejection fraction. A total of 166 symptomatic heart failure patients [New York Heart Association (NYHA) functional class II-III] with reduced left ventricular ejection fraction (≤ 40%) were recruited prospectively. Cardiorenal syndrome type 1 was defined as an acute worsening of cardiac function leading to renal dysfunction. The patients were divided into two groups with and without cardiorenal syndrome. The galectin-3 levels of all patients were determined. The primary outcome of this study was the occurrence of cardiorenal syndrome. Cardiorenal syndrome developed in 41 patients. Galectin-3 levels were found to be higher in the patients with cardiorenal syndrome (+) compared to those without cardiorenal syndrome (-) (20.7 ± 2.9 ng/mL vs. 17.8 ± 3.1 ng/mL, p < 0.001). After performing a multivariable analysis, galectin-3 levels [odds ratio (OR): 3.21, p = 0.001], NYHA functional class (OR: 1.98, p = 0.009), creatinine (OR: 3.18, p = 0.006), furosemide dose (OR: 1.21, p = 0.033), and angiotensin-converting enzyme inhibitor/angiotensin-receptor blockers usage (OR: 0.54, p = 0.029) were identified as independent predictors for the development of cardiorenal syndrome. Moreover, galectin-3 level demonstrated predictive capability for cardiorenal syndrome development (AUC = 0.761, p < 0.001). Serum galectin-3 level showed an association with cardiorenal syndrome development in patients with heart failure, indicating potential usefulness as a prognostic biomarker.

Sodium glucose cotransporter 2 inhibitor suppresses renal injury in rats with renal congestion

Renal congestion is an issue of cardiorenal syndrome in patients with heart failure. Recent clinical and basic studies suggest a renoprotective potential of sodium–glucose cotransporter (SGLT) 2 inhibitors. However, the effect on renal congestion and its mechanism is not fully understood. Thus, we aimed to clarify the effect of SGLT inhibition in a renal congestion model. Renal congestion was induced in the left kidney of male Sprague-Dawley rats by ligation of the inferior vena cava between the renal veins. The SGLT2 inhibitor tofogliflozin or vehicle was orally administered daily from the day before IVC ligation until two days after surgery. On the third postoperative day, both the right control kidney and the left congested kidney were harvested and analyzed. Kidney weight and water content was increased, and renal injury and fibrosis were observed in the left congested kidney. Kidney weight gain and hydration were improved with tofogliflozin treatment. Additionally, this treatment effectively reduced renal injury and fibrosis, particularly in the renal cortex. SGLT2 expression was observed in the congested kidney, but suppressed in the damaged tubular cells. Molecules associated with inflammation were increased in the congested kidney and reversed by tofogliflozin treatment. Mitochondrial dysfunction provoked by renal congestion was also improved by tofogliflozin treatment. Tofogliflozin protects against renal damage induced by renal congestion. SGLT2 inhibitors could be a candidate strategy for renal impairment associated with heart failure.

The Relationship between the MAGGIC Score and Cardiorenal Syndrome in Patients with Acute Decompensated Heart Failure with Reduced Ejection Fraction.

The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) is a scoring system that is easy to use in outpatient clinics or at the bedside, and was developed to predict the survival of heart failure patients after hospitalization. This study aims to evaluate the relationship between the MAGGIC score and cardiorenal syndrome (CRS) in patients with acute decompensated heart failure with reduced ejection fraction (HFrEF). This retrospective, single-center study, included 706 patients with New York Heart Association II-IV who were hospitalized and discharged for acute decompensated heart failure between 2016 and 2021. CRS type 1 was defined as acute worsening of cardiac function leading to renal dysfunction. Patients were divided into two groups: those with CRS and those without. The MAGGIC score of all patients was determined. The primary outcome was the occurrence of CRS. CRS developed in 132 patients. The MAGGIC score was higher in CRS (+) patients compared to CRS (-) patients (30.70 ± 8.09 vs. 23.96 ± 5.59, p < 0.001). After a multivariable analysis, MAGGIC score [odds ratio (OR): 3.92, p < 0.001], sodium (OR: 0.92, p = 0.003), N terminal pro B type natriuretic peptide (OR: 1.78, p = 0.009), hs troponin (OR: 1.28, p = 0.044), MRA (OR: 0.61, p = 0.019) and furosemide dose (OR: 1.03, p = 0.001) were found to be independent predictors of CRS development. The MAGGIC score was associated with CRS development (area under curve = 0.778). The MAGGIC score may be associated with CRS in HFrEF patients.

A diagnostic criterion for the dynamics of chronic kidney disease in patients with diabetes

Aim to develop and clinically substantiate an objective quantitative diagnostic criterion for the dynamics of chronic kidney disease (CKD) in patients with diabetes mellitus (DM).&#x0D; Material and methods. A comparative cross-observational study of clinical indicators was performed in a general sample of patients with type 2 diabetes, divided into groups according to the parameter "GFR reduction index (RI_GFR)", which characterizes the dynamics of CKD and the development of cardiorenal syndrome in patients with diabetes. 150 protocols of outpatient consultations were selected using the compliance criteria, including the data on 72 clinical indices. The threshold value for dividing the groups of "slow" and "fast" progression of CKD according to the RI_GFR parameter was 4.21 ml/min/1.73 m2. By the method of correlation analysis, the strength of the interrelations of clinical indicators was determined, the Student's t-test and one-factor analysis of variance were used to compare the mean values of independent variables.&#x0D; Results. To quantify the dynamics of the progression of CKD in DM patients, a diagnostic parameter RI_GFR was proposed, calculated according to the original formula based on the value of GFR and the duration of the disease of DM. When assessing the statistical relationships between RI_GFR and clinical indicators, the significance of correlations with creatinine levels, duration of diabetes, insulin therapy, age, history of acute myocardial infarction, dosage of sulfonylureas, as well as the absence of correlation with indicators of achievement of glycemic control goals was noted. When dividing the sample into groups according to the rate of progression of CKD, significant differences were found in the parameters of the duration of DM disease and the use of insulin therapy, the total dose of insulin, the level of glycemia, and body mass index. Insufficient level of reliability was found in the parameters of the dosage of sulfonylureas and age.&#x0D; Conclusion. The developed original diagnostic parameter RI_GFR allows us to give an objective characteristic of the dynamics of CKD in patients with DM. A statistically significant correlation was found between the rate of progression of diabetic kidney damage and cardiovascular risk factors with less influence of the glycemic control factor at the stage of formation of cardiorenal syndrome. To clarify the influence of hemodynamic and glycemic factors on the development of cardiorenal syndrome, it is necessary to continue the study using the logistic regression analysis.

Epidemiology and pathogenesis of cardiorenal syndrome in patients with type 2 diabetes mellitus. (Literature review)

Epidemiology and pathogenesis of cardiorenal syndrome in patients with type 2 diabetes mellitus. (Literature review)

Cardiorenal Syndrome in Patients with Infective Endocarditis Complicated by Acute Heart Failure

Cardiorenal interaction in acute heart failure (AHF) is becoming an increasingly recognized factor to consider in the management of cardiac surgical patients. Achieving adequate control of water balance and simultaneously preserving kidney function is the goal of the optimal management strategy for patients with AHF. The majority of preoperative hospitalizations to intensive care units in patients with infective endocarditis (IE) are associated with the development of AHF. The term “cardiorenal syndrome” (CRS) is used to define kidney dysfunction on the background of AHF. Due to the lack of clear clinical manifestations of CRS in IE, the diagnosis and treatment of this pathology may be delayed and contribute to the increase in the number of postoperative complications. Recent data, both in basic science and in clinical research, have changed our understanding of CRS. To date, several types of impaired interaction between the kidneys and the heart have been identified.&#x0D; The aim. To study the peculiarities of CRS in patients with IE complicated by AHF.&#x0D; Materials and methods. The basis of this study was the clinical data of 41 patients with active IE who were treated at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine from 1/1/2020 to 8/31/2020. In order to study the features of clinical manifestation and the course of CRS, a comparative analysis was conducted based on the history and results of laboratory and instrumental research for the group of patients with IE complicated by preoperative AHF, and patients without clinical manifestations of AHF at the time of hospitalization. For an in-depth study of myocardial damage in heart failure, troponin, NT-proBNP, lactate levels were analyzed; dysfunction of the urinary system was assessed by the level of urea and serum creatinine, the volume of diuresis.&#x0D; Results. A reliable relationship between the levels of NT-proBNP and serum creatinine at the preoperative stage was revealed (p˂0.001), as an indicator of the presence of CRS in patients with IE. In the early postoperative period, signs of CRS persisted in patients with IE complicated by preoperative AHF (serum creatinine 157.0±8.5 μmol/l [p&lt;0.001], NT-proBNP 8214.9±2390.0 pg/ml [p=0.010]). Normalization of kidney function indicators was reported on the day 14 after surgery.&#x0D; Conclusions. Cardiac surgical intervention in patients with IE contributes to reduction of CRS manifestations on the day 14 of the postoperative period.

Assessment of Kidney Dysfunction in Patients with Chronic Heart Failure

BACKGROUND: Heart failure and kidney disease share common pathophysiological pathways which can lead to mutual dysfunction, known as cardiorenal syndrome. The formation of cardiorenal syndrome in patients with chronic heart failure (CHF) is a natural manifestation of a functionally interconnected process at the organ level. Renal dysfunction is a common and independent factor in the progression of the disease, a high incidence of cardiovascular events, and death in the population. AIM: The aim of the study of the relationship between kidney dysfunction and the clinical course of the disease, quality of life, and indicators of the left ventricular systolic function in patients with CHF. MATERIALS AND METHODS: The study involved 150 patients with CHF I–III functional class according to the New York Heart Association. Exercise tolerance (6 min walk test) was assessed, the clinical condition was assessed using the clinical assessment scale, and the quality of life of patients with CHF (QoL) was assessed according to the Minnesota QOL questionnaire. An assessment of the functional state of the kidneys was carried out: The level of serum creatinine was determined; glomerular filtration rate (GFR) was calculated using the calculation formulas CKD-EPI. The assessment of renal blood flow was carried out using the ultrasound apparatus “SONOACEX6” (Korea). The structural and functional state of the myocardium and the process of left ventricle (LV) remodeling were assessed using the “MEDISON ACCUVIX V20” echocardiograph (Korea), using a 3.25 MHz transducer in standard echocardiographic positions, by the transthoracic method in accordance with the recommendations of the American Association of Echocardiography. RESULTS: The results of the study of physical performance according to 6 min walk test in patients of Group I with CHF GFR &gt;60 ml/min/1.73 m2 were 363.59 ± 7.6 m, respectively. The decrease in the distance traveled according to the 6 min walk test data in Group II of patients with eGFR ≤60 ml/min/1.73 m2, exercise tolerance was more pronounced than in patients of Group I and this figure was 248.7 ± 11.0 m, which was 46.2% lower than the results of Group I of the study (p &lt; 0.001). Analysis of the parameters of clinical manifestations according to the data of the clinical assessment scale showed that in patients of Group I, the total score was 5.5 ± 0.13 points. In CHF patients with renal dysfunction, changes were also noted at the level of the lobar and segmental renal arteries, characterized by a significant increase in pulsatility index and resistance index, there was a decrease in speed indicators during diastole, systole, and the average blood flow velocity. Further analysis of the parameters of LV systolic function ejection fraction (EF), as well as fractional shortening of the LV in systole (Fs%), showed that in Group II, these indicators had significant differences with Group I. There was a significant difference in EF by 10.5% and 25.4% and Fs% by 11.2% (p &lt; 0.001). CONCLUSION: In CHF patients with impaired renal function, changes in renal blood flow were characterized by a significant increase in pulsatile and resistive indices, a decrease in the rate of renal blood flow at the level of the lobar and segmental renal arteries.

Incidence and types of cardiorenal syndrome in Aswan University Hospital

Background: Heart and renal disease are common, increasingly encountered and often co-exist. Half of patients with chronic heart failure develop cardiorenal syndrome (CRS), which have a poor prognosis. Objectives: to identify the prevalence of different types &amp; risk factors associated with cardiorenal syndrome in patients presented in Aswan university hospitals. Methods: We included CRS patients with age ≥20 years old, not pregnant or lactating. We performed echocardiography and pelvic abdominal ultrasound to the included participants. Results: We included 100 participants, with average age 58.73 ± 14.81, half of them were male. The most common chronic diseases were hypertension (74.0%), and diabetes mellitus (63.0%). The prevalence of CRS type I, II, III, IV and V was 10%, 33.0%, 25.0%, 19.0%, and 13.0%, respectively. There was statistically significant relation between type of CRS and CKD (P= 0.011*).Conclusion: CRS type II had the highest prevalence of the CRS subtypes. Moreover, CKD and was a risk factor for CRS.

Galectin-3 as a Marker of Cardiorenal Syndrome in Patients with Chronic Heart Failure

Aim. To assess the effect of renal dysfunction on the galectin-3 level in patients with chronic heart failure (HF) with preserved, intermediate and reduced left ventricular ejection fraction (EF).Material and methods. Along with a clinical examination, 69 patients with HF (NYHA class II-IV) underwent tests for the level of NT-proBNP and galectin-3 in serum using enzyme immunoassay.Results. Study participants were divided into 3 groups: 23 patients with preserved EF (HFpEF), 26 patients with midrange EF (HFmrEF), 20 patients with reduced EF (HFrEF). There was a trend to increase the concentration of galectin-3 with increase in NT-proBNP level. Correlation analysis showed significant feedback (r=−0.41, p&lt;0.05) between galectin-3 and EF only in patients with preserved systolic function. In the same group of HFpEF patients, the maximum serum galectin-3 level was 10.5 [6.5; 14.5] ng/ml. Serum galectin-3 level showed negative correlated with the GFR in patients with CHF (r=−0.513, p&lt;0.05). In patients with HF and glomerular filtration rate (GFR) &lt;60 ml/min/1.73 m2 it was higher than in patients with GFR&gt;60 ml/min/1.72 m2 (9 [5.3; 12.6] ng/mL vs 11.8 [6.2; 15.3] ng/mL, p&lt;0.05). According to the ROC-analysis data, galectin-3 level &gt;10.3 ng/ml indicates a high risk of chronic kidney disease stage 3-4 stage development (sensitivity 60%, specificity 75%) and can be considered as a risk factor for development of cardiorenal syndrome in HF patients.Conclusion. Galectin-3 level in patients with HF is more influenced by the degree of reduction in GFR rather than the left ventricular systolic function impairment.

Allogeneic Cell Combination Therapy Ameliorates Chronic Kidney Disease-Induced Heart Failure with Preserved Ejection Fraction.

BackgroundLeft ventricular hypertrophy and heart failure with preserved ejection fraction (HFpEF) are primary manifestations of the cardiorenal syndrome in patients with chronic kidney disease (CKD). Therapies that improve morbidity and mortality in HFpEF are lacking. Cell-based therapies promote cardiac repair in ischemic and non-ischemic cardiomyopathies. We hypothesized that cell-based therapy ameliorates CKD-induced HFpEF.Methods and ResultsYorkshire pigs (n = 26) underwent 5/6 embolization-mediated nephrectomy. CKD was confirmed by increased creatinine and decreased glomerular filtration rate (GFR). Mean arterial pressure (MAP) was not different between groups from baseline to 4 weeks. HFpEF was evident at 4 weeks by increased LV mass, relative wall thickening, end-diastolic pressure, and end-diastolic pressure-volume relationship, with no change in ejection fraction (EF). Four weeks post-embolization, allogeneic (allo) bone marrow-derived mesenchymal stem cells (MSC; 1 × 107 cells), allo-kidney-derived stem cells (KSC; 1 × 107 cells), allo-cell combination therapy (ACCT; MSC + KSC; 1:1 ratio; total = 1 × 107 cells), or placebo (Plasma-Lyte) was delivered via intra-renal artery. Eight weeks post-treatment, there was a significant increase in MAP in the placebo group (21.89 ± 6.05 mmHg) compared to the ACCT group. GFR significantly improved in the ACCT group. EF, relative wall thickness, and LV mass did not differ between groups at 12 weeks. EDPVR improved in the ACCT group, indicating decreased ventricular stiffness.ConclusionsIntra-renal artery allogeneic cell therapy was safe in a CKD swine model manifesting the characteristics of HFpEF. The beneficial effect on renal function and ventricular compliance in the ACCT group supports further research of cell therapy for cardiorenal syndrome.

Кардиоренальный синдром у больных хронической болезнью почек и ишемической болезнью сердца

.

Predictor significance of β&lt;sub&gt;2&lt;/sub&gt;-microglobulinuria in determining the risk of cardiovascular complications in patients with chronic ischemic heart disease

BACKGROUND. The relevance of identifying new biomarkers of the cardio-renal syndrome in patients with coronary heart disease is beyond doubt. It is promising to study the indicators of tubular dysfunctions as predictors of the risk of cardiovascular complications in patients without primary kidney pathology.THE AIM. Analysis of the effect of β2-microglobulinuria on the prognosis of cardiovascular complications in patients with chronic ischemic heart disease in the long-term period after myocardial revascularization.PATIENTS AND METHODS. The study included 90 patients with coronary artery disease and indications for myocardial revascularization. Coronary bypass surgery was performed in 64 people, coronary artery stenting - in 26. Clinical and anamnestic data were collected in all patients, standard laboratory and instrumental diagnostics were performed. In addition, the level of β2-microglobulin (β2-MG) in the first morning portion of urine was determined at different study dates. The endpoint was considered to be the presence of acute forms of coronary heart disease - myocardial infarction and unstable angina. Survival after 5.8 ±0.1 years after myocardial revascularization was 69 %.RESULTS. A positive linear relationship of weak strength was established between the level of diastolic blood pressure (DBP) and β2-MG of urine obtained before myocardial revascularization (r = 0.28, p = 0.03). Moreover, the Kaplan-Meyer survival analysis showed the effect of an increase in β2-MG of urine over 0.2 ng/ml on the risk of AMI in the long-term period after myocardial revascularization (p = 0.025). It was found that an increase in the concentration of β2-MG in urine determined before myocardial revascularization is a statistically significant risk factor for the development of unstable angina in the long-term period after RM (χ2-criterion = 7.17, p = 0.007).CONCLUSION. It has been shown that an increase in the concentration of β2-MG in urine, reflecting the presence of tubular dysfunctions, can be considered as a predictor of an unfavorable cardiovascular prognosis in patients in the long-term period after myocardial revascularization.

Intrarenal Doppler Ultrasound Renal Venous Stasis Index Correlates With Acute Cardiorenal Syndrome in Patients With Acute Decompensated Heart Failure

BackgroundAcute cardiorenal syndrome (ACRS) is associated with adverse outcomes in patients with acute decompensated heart failure (ADHF). Intrarenal venous blood flow can be assessed using Doppler ultrasound and has prognostic significance in ADHF. Although intrarenal Doppler (IRD) may be sensitive to renal congestion, an association between IRD parameters and ACRS has not been demonstrated in an ADHF population. MethodsHospitalized patients with ADHF (n = 21) or acute coronary syndrome (ACS; n = 21) were prospectively enrolled. Patients underwent echocardiography, including IRD, using a standard cardiac ultrasound transducer. Intrarenal venous flow was quantified with the renal venous stasis index (RVSI), defined as the duration of absent venous flow time divided by cardiac cycle duration. The primary outcome was acute kidney injury (AKI) as assessed using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. ResultsADHF patients had a similar cardiac index (2.0 ± 0.6 vs 2.1 ± 0.4 L/min per m2, P = 0.91) but higher estimated central venous pressure (13.0 ± 3.2 vs 4.6 ± 2.4 mm Hg, P < 0.001) measured using echocardiography, compared with ACS patients. IRD was abnormal in all ADHF patients and normal in all ACS patients (RVSI 0.62 ± 0.20 vs 0.0 ± 0, P < 0.001). AKI stage II/III occurred in 10 of 21 ADHF patients (48%) vs 0 of 21 ACS patients (P < 0.001), with a mean rise in serum creatinine of 97.7 ± 79.3 vs 16.8 ± 10.9 μmol/L (P < 0.001), respectively. RVSI was correlated with AKI severity in ADHF patients (r = 0.57; P = 0.004). ConclusionsRVSI is associated with AKI among ADHF patients and may be a useful diagnostic biomarker for ACRS in this setting. Further studies are needed to validate this finding and evaluate the potential efficacy of IRD-guided decongestive therapy in this setting.

Possibilities of predicting the risk of cardiorenal syndrome in patients with chronic kidney disease on the background of congenital malformations of the urinary system

BACKGROUND. Currently, there is no doubt that there is a close relationship between the condition of the kidneys and the cardiovascular system. Neurohormonal systems various parts long-term hyperactivation is important in the development of pathological processes. Natriuretic peptides provide cardio and renoprotective effects, inhibit the activity of the renin-angiotensin-aldosterone system (RAAS). AIM. To establish the prognostic significance of determining the concentration of natriuretic peptides in comparison with the activity of RAAS in children with congenital malformations of the urinary system to assess the risk of cardiovascular complications.PATIENTS AND METHODS. 76 patients with congenital malformations OUS aged 3 to 18 years were examined: – 40 children with congenital vesicoureteral reflux, – 18 children with hydronephrosis, 18 children with other forms of OUS dysembryogenesis ( 10 patients with renal agenesis, 8-with hypoplasia). The control group consisted of 10 clinically healthy children of the appropriate age. The following parameters were determined in the blood by the enzyme immunoassay: renin, aldosterone, n-terminal propeptide of natriuretic hormone (NТ-рroВNР).RESULTS. Hyperproduction of NТ-рroВNР was observed in 61.8 % of patients, stimulation of renin and/or aldosterone production in 39.5 % of cases. Elevated levels of natriuretic peptides were found in 32.8 % of cases in 25 children with congenital OUS defects without signs of arterial hypertension (AH) and left ventricular hypertrophy (LVH). Significantly higher concentrations of (NТ-рroВNР), renin, and aldosterone are recorded in patients with AH and LVH.CONCLUSION. The increased level of natriuretic peptides is noted earlier than the clinical and instrumental signs of heart dysfunction are noticeable, it is important in identifying early stages of cardiovascular complications, evaluating the prognosis, and in justifying renoprotective treatment in pediatric Nephrology practice.

CARDIORENAL SYNDROME: THE REVIEW OF CURRENT UNDERSTANDING

Introduction. The kidneys and heart rely on each other to function properly. For the kidneys to function, they require adequate blood flow, oxygen delivery and nutrients. If heart failure develops, cardiac output is reduced, which results in decreased renal blood flow, which can lead to reversible and sometimes irreversible kidney damage. For the heart to function, regulation of extracellular volume is required. If the extracellular volume is too low, the volume of blood is insufficient to maintain cardiac output, and if the extracellular volume is too large, fluid leaks out of the capillaries, resulting in edema.Purpose. To study the relationship of the dynamic balance of the “kidney-heart” system in health and disease.Material and methods. Review of modern and foreign literary sources; methods – description, analysis, abstracting.Results and its discussion. 5 forms of cardiorenal syndrome, peculiarities of classification, pathogenesis, clinical manifestations, dynamics of imbalance in the “kidney-heart” system, issues of correction of these disorders are analyzed. They include the treatment of kidney diseases and cardiovascular pathology, prevention of the development of cardiovascular failure in accordance with modern recommendations; diet; quitting smoking, alcohol, nephrotoxic substances; control of body weight, blood pressure, glycemia; the use of angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists or angiotensin receptor blockers, statins; decrease in intra-abdominal pressure and others.Findings. Approaches to the prevention and treatment of cardiorenal syndrome in patients with kidney and heart damage are important. It is necessary to develop and introduce new approaches to nephroprotection in patients with cardiorenal syndrome, which is possible with the joint work of a multidisciplinary team.