Purpose: Renal dysfunction is widespread and associated with the poor prognosis in chronic heart failure (CHF). We aimed to estimate the relationship between predictors of CHF and renal function in Russians.
Methods: 175 CHF I-IV NYHA class patients with left ventricular ejection fraction (LVEF, Simpson) <45% without primary renal and oncological diseases were studied. Median (interquartile range) of age was 64.0(56.0-71.0) years; LVEF - 30.8(25.7-37.1) %, 86% males. We analyzed CHF predictors and estimated glomerular filtration rate (eGFR, MDRD and CKD-EPI formulas), 24-hour urinary albumin excretion (UAE). All patients were stable on optimal medical therapy.
Results: CHF was due to coronary artery disease in 81% (1 myocardial infarction (MI) in anamnesis was in 50%, 2 - in 23%, 3 - in 5%), dilated cardiomyopathy - in 9%, arterial hypertension (AH) - in 10% of patients. eGFR was lower in ischemical in comparison with non-ischemical CHF [68.2 (55.0-82.5) vs. 88.2 (65.4-98.6) ml/min/1.73m2, p = 0.006]. Number of MI correlated with eGFR (r = −0.33, p = 0.005). 76% of patients had AH in anamnesis with duration 10 (0-20) years, maximal systolic 180 (115-200) and diastolic 100 (90-110) mm Hg. eGFR was lower [66.8 (50.7-85.3) vs. 82.1 (74.4-97.3) ml/min/1.73m2, p = 0.009] and UAE was higher [50.0 (37.0-78.0) vs. 35.5 (23.6-48.1) mg/24h, p = 0.015] in patients with AH history in comparison with others. Total cholesterol >5.2 mmol/l was in 45%, triglyceride > 1.7 mmol/l - in 17% of patients. Decreased high-density lipoprotein was in 41% of patients and was associated with lower eGFR [50.6 (47.1-59.6) vs. 60.9 (52.8-68.7) ml/min/1.73m2, p = 0.044]. Diabetes mellitus (DM) was in 13.5% of patients. eGFR was lower in these patients vs. with others [54.8 (43.0-60.9) vs. 66.6 (50.5-81.6) ml/min/1.73m2, p = 0.009]. LV hypertrophy (LVH) was in 97%, abdominal obesity - in 68% of patients; 22% had 1st, 6% - 2nd and 1% - 3rd degree of obesity. 37% of patients were current smokers, 57% - smokers in the past. Duration of smoking was 30 (20-38) years, smoker index was 15 (0-30) package/years. 24% were alcohol abusers; frequency of alcohol intake was 4 (1-15) days per month. LVH, obesity, smoking and alcohol abusing weren't associated with renal dysfunction.
Conclusions: Such predictors of chronic heart failure as ischemical etiology, arterial hypertension, dyslipidemia and diabetes mellitus are associated with severity of decreasing of glomerular filtration rate and elevation of urinary albumin excretion and may contribute to progression of cardiorenal syndrome.