Cardiorenal syndrome with chronic heart failure – from a cardiologist‘s point of view

Czech version

Authors: J. Murín; M. Karabová; M. Pernický; J. Vítovec
Published in: Kardiol Rev Int Med 2012, 14(4): 246-250
Category:

Overview

Approximately 70% of patients with chronic heart failure also present renal dysfunction. The prevalence of renal dysfunction does not depend either on the type of cardiac dysfunction (systolic or „diastolic“) or the cause of such dysfunction (ischemic or accompanying a case of cardiomyopathy). It is, however, a strong prognostic risk factor for mortality and morbidity. It increases mortality by about 50 to 60%. A decrease in glomerular filtration of 10 ml per minute has the same negative prognostic power as a decrease in the left ventricular ejection fraction of 5%. In order to evaluate renal dysfunction in a patient with chronic heart failure, either a calculation of glomerular filtration according to the Cockroft-Gault formula or the so-called MDRD calculation are used. If a patient with chronic heart failure has increased serum creatinine levels while being admitted to hospital due to acute worsening of their condition, further deterioration of renal functions with the patient‘s prognosis worsening is frequently determined during hospitalization. Such patients often need to be treated with a high dose of furosemide, and such a high dose is also a marker of the patient‘s bad prognosis. Such patients receive RAAS blockers less frequently or in lower doses, which also contributes to a worsening of the prognosis. Patients with chronic heart failure and renal insufficiency are, in approximately one-third of cases, also anaemic, with the anaemia being caused by multiple factors; however, the chronic disease and renal dysfunction play an important role. Anaemia is also a bad prognostic element. It is useful from the prognostic point of view to examine and monitor these patients for biomarkers, such as troponins and natriuretic peptides. Their results and behaviour imply the therapeutic procedure. Therefore, it is necessary to know the condition of the renal dysfunction and monitor its changes in the diagnostics and treatment of a patient with chronic heart failure. It helps in determining the treatment and prognosis.

Keywords:
chronic heart failure – renal dysfunction – heart failure prognosis – anaemia – biomarkers – troponin – natriuretic peptides – heart failure therapy

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