Early diagnosis of acute renal injury in patients with acute decompensation of chronic heart failure


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Abstract

Early diagnosis of acute kidney injury (AKI) is an urgent problem of providing medical care to patients with acute decompensation of chronic heart failure (ADHF). Aim. To study the possibilities of previously diagnosing acute renal damage in patients with acute decompensation of chronic heart failure with reduced systolic function using biomarkers of acute renal injury. Materials and methods. The study included 60 patients (62.0±11.1 years) with HADS (BNP >500 pg/ml) and a reduced left ventricular ejection fraction (LV 27.05% [23.25; 32.75], c FC III-IV NYHA). The level of creatinine, urea, uric acid, albumin in serum was determined in all patients, as well as a number of biomarkers: lipocalin associated with neutrophil gelatinase (NGAL) and cystatin C (CysC) in serum; kidney damage molecule-1 (KIM-1) and angiotensinogen (AGT) in the urine. Results and discussion. AKI is determined based on changes in serum creatinine concentration or diuresis value. The results obtained indicate a high specificity and sensitivity of the use of biomarkers for the diagnosis of AKI in patients with ADHF. NGAL AUC - 0.833 (p<0.001), Se - 82.8%, Sp - 4.2%. CysC AUC - 0.823 (p<0.001), Se - 79.3%, Sp - 74.2%. KIM-1 AUC - 0.782 (p<0.001), Se - 75.9%, Sp - 74.2%. AGT AUC - 0.829 (p<0.001), Se - 82.8%, Sp - 77.4%. In a multifactorial regression analysis, it was found that with NGAL greater than 157.35 ng/ml, the risk of AKI increases 13.1 times (95% CI 1.365-126.431), with an increase in KIM-1, the risk of the development of AKI increases 20.6 times (95% CI 1.802-235.524), and with an increase in AGT more than 14.31 leng/ml, the risk of AKI increases 32.8 times (95% CI 2.752-390.110). Conclusion. Acute kidney injury develops in 48.3% of patients hospitalized with acute decompensation of chronic heart failure. Patients with acute decompensation of chronic heart failure and AKI have significantly higher serum NGAL and CysC, KIM-1 and AGT values in the urine compared with patients without impairing renal function. These biomarkers can serve both for the early diagnosis of acute kidney damage and the prediction of AKI in patients with acute decompensation of chronic heart failure.

About the authors

S N Nasonova

National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation

Email: dr.nasonova@mail.ru
к.м.н., с.н.с. отд. заболеваний миокарда и сердечной недостаточности НИИ клинической кардиологии им. А.Л. Мясникова ФГБУ «НМИЦ кардиологии» Moscow, Russia

I V Zhirov

National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation; Russian Medical Academy Continuous Professional Education of the Ministry of Health of the Russian Federation

д.м.н., в.н.с. отд. заболеваний миокарда и сердечной недостаточности НИИ клинической кардиологии им. А.Л. Мясникова ФГБУ «НМИЦ кардиологии», проф. каф. кардиологии ФГБОУ ДПО «РМАНПО» Moscow, Russia

M V Ledyakhova

National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation

аспирант отд. заболеваний миокарда и сердечной недостаточности НИИ клинической кардиологии им. А.Л. Мясникова ФГБУ «НМИЦ кардиологии» Moscow, Russia

T V Sharf

National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation

к.б.н., н.с. лаб. иммунохимии НИИ экспериментальной кардиологии ФГБУ «НМИЦ кардиологии» Moscow, Russia

E G Bosykh

National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation

врач-лаборант отд. нейрогуморальных и иммунологических исследований НИИ клинической кардиологии им. А.Л. Мясникова ФГБУ «НМИЦ кардиологии» Moscow, Russia

V P Masenko

National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation

д.м.н., проф., руководитель отд. нейрогуморальных и иммунологических исследований ФГБУ «НМИЦ кардиологии» Moscow, Russia

S N Tereshchenko

National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation; Russian Medical Academy Continuous Professional Education of the Ministry of Health of the Russian Federation

д.м.н., проф., первый зам. ген. директора, зам. ген. директора по научной работе, руководитель отд. заболеваний миокарда и сердечной недостаточности ФГБУ «НМИЦ кардиологии», зав. каф. кардиологии ФГБОУ ДПО «РМАНПО» Moscow, Russia

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