Prevalence, correlative and statistical relationships of renal dysfunction in patients with chronic ischemic heart failure
DOI:
https://doi.org/10.14739/2310-1210.2014.1.23662Keywords:
chronic heart failure, prevalence, kidney dysfunctionAbstract
Chronic heart failure (CHF) is one of the most common complications of cardiovascular disease. According multicenter studies conducted during recent years, coronary heart disease was the leading cause of heart failure and has been on average 64% of patients with chronic heart failure. The tight functional relationship of cardiovascular and urinary system causes a lot of interest to the functional state of kidneys in various cardiovascular diseases. Most risk factors for cardiovascular disease are common risk factors of renal failure. Causes significant differences in the prevalence of chronic kidney disease (CKD) in patients with chronic heart failure, defined as coronary artery disease and hypertension remain unclear. Need clarification prevalence of CKD among patients with CHF in general and in specific groups of patients.
The aim of the study was to examine the prevalence, correlation and statistical relationships of renal dysfunction with functional class, age and gender of patients with coronary heart disease and heart failure, were hospitalized.
Materials and methods. Analyzed the medical cards 344 patients (286 men and 58 women) with ischemic chronic heart failure, mean age 59.2±9.4 years. The etiology of heart failure in 298 (86.6%) patients had a combination of coronary artery disease and essential hypertension in 46 (13.4%) - CHD. Chronic heart failure 1 functional class (FC) was diagnosed in 10 (2.9%) patients, 2 FC - in 106 (31%), 3 FC - 207 (60.5%) and 4 FC - 19 (5, 6%) patients. Diabetes was 62 (18%) patients. Myocardial infarction had a history of 245 (71.2%) patients. Glomerular filtration rate was calculated using the formula MDRD (Modification of Diet in Renal Disease). Descriptive statistics are presented as mean±standard deviation for continuous variables and as percentages for categorical variables. Depending on the distribution of the analyzed parameters used unpaired Student's t-test or U-Mann-Whitney test. Comparisons among all groups for baseline clinical variables were performed with the Pearson χ2 or Fisher exact test for categorical variables. Differences considered reliable for values of p<0,05.
Results. The total number of patients with chronic renal dysfunction (GFR less than 90 ml/min/1.73 m2) - 269 (78.2%). Decreased GFR less than 60 ml/min/1.73 m2 detected in 43 (12.5%) patients with CHF. In 60% of patients up to 45 years, 74.5% from 45 to 59 years, 83.4% aged 60 to 75 years and in 91.7 % of patients aged over 75 years revealed chronic renal dysfunction. The prevalence of CKD among patients with heart failure also increased with the growth of CHF severity. For example, among patients with FC 1 (10%) was observed GFR <60 ml/min/1.73 m2. In the group with FC II: signs of CKD detected in 7.5% patients. In the presence of more severe heart failure (FC III) - found 13.5% patients with evidence of CKD, 60 to 90 ml/min/1.73 m2 in 69.7%. Heart failure is characterized by IV FC progressive decrease of renal function, as reflected by the presence of signs of CKD in 31.6% and a moderate decrease in GFR of 60 to 90 ml/min/1.73 m2 in 47.4% patients. Ischemic heart failure, associated with GFR less than 60 ml/min/1.73 m2 is more common in men (12.9% vs 10.3%, χ2=0.3, p=0.58). Correlation analysis showed sustained statistically significant association between eGFR and age (r=-0,34, p<0,001), FC CHF (r=-0,21, p<0,001). High prevalence of CKD among patients with heart failure and poor prognosis requires strengthening of medical institutions for early detection of renal dysfunction in patients with diseases of the cardiovascular system.
Conclusion. Thus, ischemic heart failure characterized by reduced filtration capacity of the kidneys and is inversely related to age and functional class. Prevalence of renal dysfunction among patients with ischemic heart failure is 78.2% and it increases with the age of patients and functional class.
The perspective is to further explore the prognostic significance of the detected change, the possibility of pharmacological correction in patients with ischemic chronic heart failure, depending on age, sex, functional class, left ventricular contractile ability.
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