Chronic kidney disease and chronic heart failure: impact on prognosis and choice of pathogenetic therapy
- Authors: Mezhonov E.M.1,2, Reitblat O.M.2, Vyalkina Y.A.1, Airapetian A.A.3, Lazareva N.V.3, Ageev F.T.3, Blankova Z.N.3, Svirida O.N.3, Prints Y.S.2, Zhirov I.V.3,4, Tereshchenko S.N.3, Boytsov S.A.3
-
Affiliations:
- Tyumen State Medical University
- Regional Clinical Hospital №1
- Chazov National Medical Research Center of Cardiology
- Russian Medical Academy of Continuous Professional Education
- Issue: Vol 96, No 7 (2024): VARIO
- Pages: 666-674
- Section: Original articles
- URL: https://journals.rcsi.science/0040-3660/article/view/262136
- DOI: https://doi.org/10.26442/00403660.2024.07.202781
- ID: 262136
Cite item
Full Text
Abstract
Aim. To evaluate the impact of a decrease in glomerular filtration rate (GFR) on the prognosis of patients with chronic heart failure (CHF), to analyze real clinical practice regarding the frequency of prescribing pathogenetic therapy for CHF, achieving target dosages depending on the gradation of GFR in patients included in the CHF Register of the Tyumen region.
Materials and methods. The analysis included medical data of 4077 patients (1662 men and 2415 women) with NYHA class I–IV CHF who underwent examination and treatment in medical organizations of the Tyumen region for the period from January 2020 to May 2023. Criteria for inclusion in the register: proven heart failure. Chronic kidney disease (CKD) was assessed by GFR calculated using the CKD-EPI formula (ml/min/1.73 m2). The primary end point was defined as death from all causes.
Results. GFR<60 ml/min/1.73 m2 was recorded in 34.6% of patients, more common in women (40.2 and 26.6%, respectively; p<0.001). When dividing patients into phenotypes according to LVEF, no statistically significant differences were found in the distribution of patients according to GFR. In patients with HFrEF and HFpEF GFR<45 ml/min/1.73 m2 was associated with an increased risk of meeting the endpoint. Analysis of prescribed pathogenetic therapy showed that in patients with HFrEF, the frequency of prescription of ACE inhibitors, â-blockers and MRA decreased (p=0.023, 006 and 0.01, respectively), and ARNI, on the contrary, increased with a decrease in GFR (p=0.026). In patients with HFpEF, a similar trend towards a decrease in the frequency of prescription of ACEIs and MCBs with a decrease in GFR (p<0.001) remained, but it was compensated by an inversely proportional increase in the frequency of prescription of ARBs (p<0.001). 100% of the target dosage is achieved in more than 90% of patients taking MRA across the entire LVEF range. While for â-blockers and ARNI/ACE/ARB the percentage of patients receiving the full therapeutic dosage of drugs is significantly lower. When analyzing target dosages of pathogenetic drugs, gradations of achieved doses were distributed evenly throughout the entire range of GFR.
Conclusion. GFR<60 ml/min/1.73 m2 occurs in every 3 patients with CHF across the entire range of LVEF. A decrease in GFR worsens the prognosis of patients with both HFrEF and HFpEF, increasing in direct proportion with the severity of the stage of CKD. Inclusion of patients in the monitoring program within the framework of the CHF service allows the treatment to be significantly brought closer to optimal drug therapy, at the same time, certain efforts are required to overcome difficulties with titration to target dosages.
Keywords
Full Text
##article.viewOnOriginalSite##About the authors
Evgeny M. Mezhonov
Tyumen State Medical University; Regional Clinical Hospital №1
Author for correspondence.
Email: emmrus@mail.ru
ORCID iD: 0000-0002-6086-4578
д-р мед. наук, проф. каф. кардиологии и кардиохирургии с курсом скорой помощи Института клинической медицины; врач-кардиолог
Russian Federation, Tyumen; TyumenOleg M. Reitblat
Regional Clinical Hospital №1
Email: emmrus@mail.ru
ORCID iD: 0000-0002-9407-5497
канд. мед. наук, рук. Регионального сосудистого центра; главный внештатный специалист – кардиолог Минздрава России УФО
Russian Federation, TyumenYulia A. Vyalkina
Tyumen State Medical University
Email: emmrus@mail.ru
ORCID iD: 0000-0001-6470-5606
канд. мед. наук, доц. каф. госпитальной терапии с курсом эндокринологии Института клинической медицины
Russian Federation, TyumenAnna A. Airapetian
Chazov National Medical Research Center of Cardiology
Email: emmrus@mail.ru
ORCID iD: 0000-0002-7064-5328
лаборант-исследователь лаб. мониторинга программ по снижению смертности от сердечно-сосудистых заболеваний
Russian Federation, MoscowNatalia V. Lazareva
Chazov National Medical Research Center of Cardiology
Email: emmrus@mail.ru
ORCID iD: 0000-0002-3253-0669
канд. мед. наук, вед. науч. сотр. лаб. мониторинга программ по снижению смертности от сердечно-сосудистых заболеваний
Russian Federation, MoscowFail T. Ageev
Chazov National Medical Research Center of Cardiology
Email: emmrus@mail.ru
ORCID iD: 0000-0003-4369-1393
д-р мед. наук, проф., рук. научно-диспансерного отд.
Russian Federation, MoscowZoya N. Blankova
Chazov National Medical Research Center of Cardiology
Email: emmrus@mail.ru
ORCID iD: 0000-0002-9858-6956
канд. мед. наук, науч. сотр., врач-кардиолог
Russian Federation, MoscowOlga N. Svirida
Chazov National Medical Research Center of Cardiology
Email: emmrus@mail.ru
ORCID iD: 0000-0003-1317-036X
канд. мед. наук, мл. науч. сотр., врач-кардиолог
Russian Federation, MoscowYulia Sh. Prints
Regional Clinical Hospital №1
Email: emmrus@mail.ru
ORCID iD: 0000-0001-8331-6307
зав. кардиологическим отд-нием №1; гл. внештатный специалист – кардиолог Департамента здравоохранения Тюменской области
Russian Federation, TyumenIgor V. Zhirov
Chazov National Medical Research Center of Cardiology; Russian Medical Academy of Continuous Professional Education
Email: emmrus@mail.ru
ORCID iD: 0000-0002-4066-2661
д-р мед. наук, вед. науч. сотр. отд. заболеваний миокарда и сердечной недостаточности; проф. каф. кардиологии
Russian Federation, Moscow; MoscowSergey N. Tereshchenko
Chazov National Medical Research Center of Cardiology
Email: emmrus@mail.ru
ORCID iD: 0000-0001-9234-6129
д-р мед. наук, проф., рук. отд. заболеваний миокарда и сердечной недостаточности
Russian Federation, MoscowSergey A. Boytsov
Chazov National Medical Research Center of Cardiology
Email: emmrus@mail.ru
ORCID iD: 0000-0001-6998-8406
акад. РАН, д-р мед. наук, проф., ген. дир.; гл. внештатный специалист – кардиолог Минздрава России Центрального, Уральского, Сибирского и Дальневосточного федеральных округов
Russian Federation, MoscowReferences
- Schefold JC, Filippatos G, Hasenfuss G, et al. Heart failure and kidney dysfunction: epidemiology, mechanisms and management. Nat Rev Nephrol. 2016;12(10):610-23. doi: 10.1038/nrneph.2016.113
- Nicolas J, Claessen B, Mehran R. Implications of Kidney Disease in the Cardiac Patient. Int Cardiol Clin. 2020;9(3):265-78. doi: 10.1016/j.iccl.2020.03.002
- Ruocco G, Palazzuoli A, ter Maaten JM. The role of the kidney in acute and chronic heart failure. Heart Fail Rev. 2020;25(1):107-18. doi: 10.1007/s10741-019-09870-6
- Beldhuis IE, Lam CSP, Testani JM, et al. Evidence-Based Medical Therapy in Patients With Heart Failure With Reduced Ejection Fraction and Chronic Kidney Disease. Circulation. 2022;145(9):693-712. doi: 10.1161/CIRCULATIONAHA.121.052792
- Li X, Lindholm B. Cardiovascular Risk Prediction in Chronic Kidney Disease. Am J Nephrol. 2022;53(10):730-9. doi: 10.1159/000528560
- Pontremoli R, Borghi C, Perrone Filardi P. Renal protection in chronic heart failure: focus on sacubitril/valsartan. Eur Heart J Cardiovasc Pharmacother. 2021;7(5):445-52. doi: 10.1093/ehjcvp/pvab030
- Wheeler DC, Stefánsson BV, Jongs N, et al. Effects of dapagliflozin on major adverse kidney and cardiovascular events in patients with diabetic and non-diabetic chronic kidney disease: a prespecified analysis from the DAPA-CKD trial. Lancet Diabetes Endocrinol. 2021;9(1):22-31. doi: 10.1016/S2213-8587(20)30369-7
- The EMPA-KIDNEY Collaborative Group; Herrington WG, Staplin N, et al. Empagliflozin in Patients with Chronic Kidney Disease. New Engl J Med. 2023;388(2):117-27. doi: 10.1056/NEJMoa2204233
- Banerjee D, Rosano G, Herzog CA. Management of heart failure patient with CKD. Clin J Am Soc Nephrol. 2021;16(7):1131-9. doi: 10.2215/CJN.14180920
- Wetmore JB, Yan H, Horne L, et al. Risk of hyperkalemia from renin-angiotensin-aldosterone system inhibitors and factors associated with treatment discontinuities in a real-world population. Nephrol Dial Transplant. 2021;36(5):826-39. doi: 10.1093/ndt/gfz263
- McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-726. doi: 10.1093/eurheartj/ehab368
- Кобалава Ж.Д., Конради А.О., Недогода С.В., и др. Артериальная гипертензия у взрослых. Клинические рекомендации 2020. Российский кардиологический журнал. 2020;25(3):3786 [Kobalava ZhD, Konradi AO, Nedogoda SV, et al. Arterial hypertension in adults. Clinical guidelines 2020. Russian Journal of Cardiology. 2020;25(3):3786 (in Russian)]. doi: 10.15829/1560-4071-2020-3-3786
- Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604-12. doi: 10.7326/0003-4819-150-9-200905050-00006
- Дедов И.И., Мокрышева Н.Г., Мельниченко Г.А., и др. Ожирение. Клинические рекомендации. Consilium Medicum. 2021;23(4):311-25 [Dedov II, Mokrysheva NG, Mel’nichenko GA, et al. Obesity. Clinical guidelines. Consilium Medicum. 2021;23(4):311-25 (in Russian)]. doi: 10.26442/20751753.2021.4.200832
- Фомин И.В. Хроническая сердечная недостаточность в Россиийской Федерации: что сегодня мы знаем и что должны делать. Российский кардиологический журнал. 2016;(8):7-13 [Fomin IV. Chronic heart failure in Russian Federation: what do we know and what to do. Russian Journal of Cardiology. 2016;(8):7-13 (in Russian)]. doi: 10.15829/1560-4071-2016-8-7-13
- Хадзегова А.Б. Функция почек при сердечной недостаточности – предиктор выбора блокаторов РААС. РМЖ. Медицинское обозрение. 2023;7(1):30-5 [Khadzegova AB. Renal function in patients with heart failure – a predictor for selecting RAAS inhibitors. Russian Medical Inquiry. 2023;7(1):30-5 (in Russian)]. doi: 10.32364/2587-6821-2023-7-1-30-35
- Lawson CA, Zaccardi F, Squire I, et al. Risk Factors for Heart Failure: 20-Year Population-Based Trends by Sex, Socioeconomic Status, and Ethnicity. Circ Heart Fail. 2020;13(2):e006472. doi: 10.1161/CIRCHEARTFAILURE.119.006472
- Шляхто Е.В., Беленков Ю.Н., Бойцов С.А., и др. Результаты промежуточного анализа проспективного наблюдательного многоцентрового регистрового исследования пациентов с хронической сердечной недостаточностью в Российской Федерации ‘ПРИОРИТЕТ-ХСН’: исходные характеристики и лечение первых включенных пациентов. Российский кардиологический журнал. 2023;28(10):5593 [Shlyakhto EV, Belenkov YuN, Boytsov SA, et al. Interim analysis of a prospective observational multicenter registry study of patients with chronic heart failure in the Russian Federation “PRIORITET-CHF”: initial characteristics and treatment of the first included patients. Russian Journal of Cardiology. 2023;28(10):5593 (in Russian)]. doi: 10.15829/1560-4071-2023-5593
- Khan MS, Samman Tahhan A, Vaduganathan M, et al. Trends in prevalence of comorbidities in heart failure clinical trials. Eur J Heart Fail. 2020;22(6):1032-42. doi: 10.1002/ejhf.1818
- Löfman I, Szummer K, Hagerman I, et al. Prevalence and prognostic impact of kidney disease on heart failure patients. Open Heart. 2016;3(1):e000324. doi: 10.1136/openhrt-2015-000324
- Packer M, Anker SD, Butler J, et al. Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. New Engl J Med. 2020;383(15):1413-24. doi: 10.1056/NEJMoa2022190
- Поляков Д.С., Фомин И.В., Беленков Ю.Н., и др. Хроническая сердечная недостаточность в Российской Федерации: что изменилось за 20 лет наблюдения? Результаты исследования ЭПОХА–ХСН. Кардиология. 2021;61(4):4-14 [Polyakov DS, Fomin IV, Belenkov YuN, et al. Chronic heart failure in the Russian Federation: what has changed over 20 years of follow-up? Results of the EPOCH-CHF study. Kardiologiia. 2021;61(4):4-14 (in Russian)]. doi: 10.18087/cardio.2021.4.n1628
- Greene SJ, Butler J, Albert NM, et al. Medical Therapy for Heart Failure With Reduced Ejection Fraction. J Am Coll Cardiol. 2018;72(4):351-66. doi: 10.1016/j.jacc.2018.04.070
- Komajda M, Anker SD, Cowie MR, et al. Physicians’ adherence to guideline-recommended medications in heart failure with reduced ejection fraction: data from the QUALIFY global survey. Eur J Heart Fail. 2016;18(5):514-22. doi: 10.1002/ejhf.510
- Фомин И.В., Поляков Д.С., Вайсберг А.Р. 25 лет реальной клинической практики в лечении хронической сердечной недостаточности в РФ – все ли мы правильно делаем в 2022 году? Медицинский альманах. 2022;4(73):27-37 [Fomin IV, Polyakov DS, Vaisberg AR. 25 years of chronic heart failure treatment in clinical practice in the Russian Federation – are we doing everything right in 2022. Meditsinskii Almanakh. 2022;4(73):27-37 (in Russian)].
Supplementary files
![](/img/style/loading.gif)