Chronic kidney disease and chronic heart failure: impact on prognosis and choice of pathogenetic therapy
- 作者: Mezhonov E.1,2, Reitblat O.2, Vyalkina Y.1, Airapetian A.3, Lazareva N.3, Ageev F.3, Blankova Z.3, Svirida O.3, Prints Y.2, Zhirov I.3,4, Tereshchenko S.3, Boytsov S.3
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隶属关系:
- Tyumen State Medical University
- Regional Clinical Hospital №1
- Chazov National Medical Research Center of Cardiology
- Russian Medical Academy of Continuous Professional Education
- 期: 卷 96, 编号 7 (2024): VARIO
- 页面: 666-674
- 栏目: Original articles
- URL: https://journals.rcsi.science/0040-3660/article/view/262136
- DOI: https://doi.org/10.26442/00403660.2024.07.202781
- ID: 262136
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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.
作者简介
Evgeny Mezhonov
Tyumen State Medical University; Regional Clinical Hospital №1
编辑信件的主要联系方式.
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
俄罗斯联邦, Tyumen; TyumenOleg 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
俄罗斯联邦, TyumenYulia 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
俄罗斯联邦, TyumenAnna 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
俄罗斯联邦, MoscowNatalia 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
俄罗斯联邦, MoscowFail 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.
俄罗斯联邦, MoscowZoya 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
俄罗斯联邦, MoscowOlga 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
俄罗斯联邦, MoscowYulia 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
俄罗斯联邦, TyumenIgor 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
俄罗斯联邦, Moscow; MoscowSergey 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
俄罗斯联邦, MoscowSergey 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
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