#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

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


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


Sources

1. Smith GL, Lichtman JH, Bracken MB et al. Renal impairment and outcomes in heart failure: systematic review and meta-analysis. J Am Coll Cardiol 2006; 47: 1987–1996.

2. Hillege HL, Nitsch D, Pfeffer MA et al. Renal function as a predictor of outcome in a broad spectrum of patients with heart failure. Circulation 2006; 113: 671–678.

3. Smilde TD, Hillege HL, Navis G et al. Impaired renal function in patients with ischemic and nonischemic chronic heart failure: association with neurohormonal activation and survival. Am Heart J 2006; 148: 165–172.

4. Ronco C, McCullough P, Anker SD et al. Cardio--renal syndromes: report from the consensus conference of the acute dialysis quality initiative. Eur Heart J 2010; 31: 703–711.

5. Smilde TD, van Veldhuisen DJ, Navis G et al. Drawbacks and prognostic value of formulas estimating renal function in patients with chronic heart failure and systolic dysfunction. Circulation 2006; 15: 1572–1580.

6. Forman DE, Butler J, Wang Y et al. Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure. J Am Coll Cardiol 2004; 43: 61–67.

7. Krumholz HM, Chen YT, Vaccarino V et al. Correlates and impact on outcomes of worsening renal function in patients ≥ 65 years of age with heart failure. Am J Cardiol 2000; 85: 1110–1113.

8. Cowie MR, Komajda M, Murray-Thomas T et al. Prevalence and impact of worsening renal function in patients hospitalized with decompensated heart failure: results of the prospective outcomes study in heart failure (POSH). Eur Heart J 2006; 27: 1216–1222.

9. Abdel-Qadir HM, Tu JV, Yun L et al. Diuretic dose and long-term outcomes in elderly patients with heart failure after hospitalization. Am Heart J 2010; 160: 264–271.

10. Ahmed A, Young JB, Love TE et al. A propensity--matched study of the effects of chronic diuretic therapy on mortality and hospitalization in older adults with heart failure. Int J Cardiol 2008; 125: 246–253.

11. Berger AK, Duval S, Manske C et al. Angiotensin--converting enzyme inhibitors and angiotensin receptor blockers in patients with congestive heart failure and chronic kidney disease. Am Heart J 2007; 153: 1064–1073.

12. Ahmed A, Centor M, Weaver MT et al. A propensity score analysis of the impact of angiotensin-converting enzyme inhibitors on long-term survival of older adults with heart failure and perceived contraindica­tions. Am Heart J 2005; 149: 737–743.

13. Massie BM, Armstrong PW, Cleland JG et al. Toleration of high doses of angiotensin-converting enzyme inhibitors in patients with chronic heart failure: results from the ATLAS trial. Arch Intern Med 2001; 161: 165–171.

14. Bakris GL, Weir MR. Angiotensin-converting enzyme inhibitor-associated elevations in serum creatinine: is this a cause for concern? Arch Intern Med 2000; 160: 685–693.

15. Comper WD, Hilliard LM, Nikolic-Paterson DJ et al. Disease-dependent mechanisms of albuminuria. Am J Physiol Renal Physiol 2008; 295: F1589–F1600.

16. Gansevoort RT, de Jong PE. The case for using albuminuria in staging chronic kidney disease. J Am Soc Nephrol 2009; 20: 465–468.

17. Anand IS, Bishu K, Rector TS et al. Proteinuria, chronic kidney disease, and the effect on an angiotensin receptor blocker in addition to an angiotensin--converting enzyme inhibitor in patients with moderate to severe heart failure. Circulation 2009; 120: 1577–1584.

18. Masson S, Latini R, Milani V et al. Prevalence and prognostic value of elevated urinary albumin excretion in patients with chronic heart failure: data from the GISSI-Heart failure trial. Circulation Heart Failure 2010; 3: 65–72.

19. Arnlöv J, Evans JC, Meigs JB et al. Low-grade albuminuria and incidence of cardiovascular disease events in nonhypertensive and nondiabetic individuals: the Framingham heart study. Circulation 2005; 112: 969–975.

20. Tonelli M, Jose P, Curhan G et al. Proteinuria, impaired kidney function, and adverse outcomes in people with coronary disease: analysis of a previously conducted randomised trial. BMJ 2006; 332: 1426.

21. Jackson CE, Soloman SD, Gerstein et al. Albuminuria in chronic heart failure: prevalence and prognostic importance. Lancet 2009; 374: 543–550.

22. Groenveld HF, Januzzi JL, Damman K et al. Anemia and mortality in heart failure patients a systematic review and meta-analysis. J Am Coll Cardiol 2008; 52: 818–827.

23. McClellan W, Aronoff L, Bolton K et al. The prevalence of anemia in patients with chronic kidney disease. Curr Med Res Opin 2004; 20: 1501–1510.

24. Nurko S. Anemia in chronic kidney diseases: causes, diagnosis, treatment. Cleve Clin J Med 2006; 73: 289–297.

25. Opasich C, Cazzola M, Scelsi L et al. Blunted erythropoietin production and defective iron supply for erythropoiesis as major causes of anaemia in pa­tients with chronic heart failure. Eur Heart J 2005; 26: 2232–2237.

26. Anand IS, Rector T, Deswal A. Relationship between proinflammatory cytokines and anemia in heart failure. Eur Heart J 2006; 27 (Suppl 1): 485.

27. Anand IS. Anemia and chronic heart failure implications and treatment options. J Am Coll Cardiol 2008; 52: 501–511.

28. Volpe M, Tritto C, Testa U et al. Blood levels of erythropoietin in congestive heart failure and correlation with clinical, hemodynamic, and hormonal profiles. Am J Cardiol 1994; 74: 468–473.

29. Go AS, Yang J, Ackerson LM et al. Hemoglobin level, chronic kidney disease, and the risks of death and hospitalization in adults with chronic heart failure: the Anemia in Chronic Heart Failure: outcomes and resource utilization (ANCHOR) study. Circulation 2006; 113: 2713–2723.

30. Kazory A, Ross EA. Anemia: the point of convergence or divergence for kidney disease and heart failure? J Am Coll Cardiol 2009; 53: 639–647.

31. Komajda M, Anker SD, Charlesworth et al. The impact of new onset anaemia on morbidity and mortality in chronic heart failure: results from COMET. Eur Heart J 2006; 27: 1440–1446.

32. Felker GM, Shaw LK, Stough WG et al. Anemia in patients with heart failure and preserved systolic function. Am Heart J 2006; 151: 457–462.

33. Walker AM, Schneider G, Yeaw J et al. Anemia as a predictor of cardiovascular events in patients with elevated serum creatinine. J Am Soc Nephrol 2006; 17: 2293–2298.

34. You JJ, Austin PC, Alter DA et al. Relation between cardiac troponin I and mortality in acute decompensated heart failure. Am Heart J 2007; 153: 462–470.

35. Tsutamoto T, Kawahara C, Yamaji M et al. Relationship between renal function and serum cardiac troponin T in patients with chronic heart failure. Eur J Heart Fail 2009; 11: 653–658.

36. Sharma R, Gaze DC, Pellerin D et al. Cardiac structural and functional abnormalities in end stage renal disease patients with elevated cardiac troponin T. Heart 2006; 92: 804–809.

37. Khan NA, Hemmelgarn BR, Tonelli M et al. Prognostic value of troponin T and I among asymptomatic patients with end-stage renal disease: a meta-analysis. Circulation 2005; 112: 3088–3096.

38. Maisel A, Mueller C, Adams K Jr et al. State of the art: using natriuretic peptide levels in clinical practice. Eur J Heart Fail 2008; 10: 824–839.

39. Doust JA, Pietrzak E, Dobson A et al. How well does B-type natriuretic peptide predict death and cardiac events in patients with heart failure: systemic review. BMJ 2005; 330: 625–627.

40. Cleland JG, Taylor J, Tendera M. Prognosis in heart failure with a normal ejection fraction. N Engl J Med 2007; 357: 829–830.

41. Niizuma S, Iwanaga Y, Yahata T et al. Impact of left ventricular end-diastolic wall stress on plasma B-type natriuretic peptide in heart failure with chronic kidney disease and end-stage renal disease. Clin Chem 2009; 55: 1347–1353.

42. Bruch C, Fischer C, Sindermann J et al. Comparison of the prognostic usefulness of N-terminal pro--brain natriuretic peptide in patients with heart failure with versus without chronic kidney disease. Am J Cardiol 2008; 102: 469–474.

43. Anwaruddin S, Lloyd-Jones DM, Baggish A et al. Renal function, congestive heart failure, and amino--terminal pro-brain natriuretic peptide measurement: results from the ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) study. J Am Coll Cardiol 2006; 47: 91–97.

44. Damman K, Van Veldhuisen DJ, Navis G et al. Tubular damage in chronic systolic heart failure is associa­ted with reduced survival independent of glomerular filtration rate. Heart 2010; 96: 1297–1302.

45. Lassus J, Harjola VP, Sund R et al. Prognostic value of cystatin C in acute heart failure in relation to other markers of renal function and NT-proBNP. Eur Heart J 2007; 28: 1841–1847.

46. Yigla M, Nakhoul F, Sabag A et al. Pulmonary hypertension in patients with end-stage renal disease. Chest 2003; 123: 1577–1582.

47. Yigla M, Abassi Z, Reisner SA et al. Pulmonary hypertension in hemodialysis patients: an unrecognized threat. Semin Dial 2006; 19: 353–357.

Labels
Paediatric cardiology Internal medicine Cardiac surgery Cardiology
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#