CHRONIC KIDNEY DISEASE AND CHRONIC HEART FAILURE: IMPACT ON PROGNOSIS OF THERAPY

Abstract

Background. Chronic heart failure (CHF) is a serious problem of modern healthcare, being a consumer of significant material resources due to high frequency of hospitalisation and unfavourable prognosis. CHF quite often coexists with a number of comorbidities, among which chronic kidney disease (CKD) is of particular importance

Objective. To evaluate the impact of decreased glomerular filtration rate (GFR) on the prognosis of patients with chronic heart failure (CHF), to analyse clinical practice with regard to the frequency of prescription of pathogenetic therapy for CHF, achievement of target doses depending on the gradation of GFR in patients.

Materials and Methods. Medical data of 102 patients (40 men and 62 women) with CHF of I-IV functional class NYHA were included in the analysis. Inclusion criteria in the register: proven CHF. Chronic kidney disease was assessed by (GFR) calculated by the CKD-EPI formula (ml/min/1.73 m2). The primary endpoint was defined as all-cause death.

Results. (GFR)<60 ml/min/1.73 m2 was registered in 31.2% of patients, more frequently in women (39 and 28.8%, respectively; p<0.001). When dividing patients into phenotypes according to left ventricular ejection fraction (LVEF), no statistically significant differences were found in the distribution of patients according to(GFR). In patients with CHF with low LVEF (HFlEF) and CHF with preserved LVEF (HFpEF), an GFR<45 ml/min/1.73 m2 was associated with an increased risk of endpoints. Analysis of the prescribed pathogenetic therapy showed that in patients with HFlFV the frequency of prescription of angiotensin-converting enzyme inhibitors (ACEIs), β-adrenoblockers and mineralocorticoid receptor antagonists (MCRAs) decreased (p=0.024, 0.007 and 0.01 respectively), while angiotensin receptor and neprilysin inhibitor increased with decreasing(GFR) (p=0.027). In patients with CHFV, a similar trend of decreasing frequency of prescription of IAPPs and MCRAs with decreasing CRP (p<0.001) persisted, but it was compensated by an inversely proportional increase in the frequency of prescription of angiotensin receptor blockers (p<0.001). One hundred per cent of the target dosage was achieved by more than 85% of patients taking AMKR across the entire range of LVEF, whereas for β-adrenoblockers and angiotensin receptor and neprilysin inhibitor/IAPP/angiotensin receptor blockers the percentage of patients receiving the full therapeutic dosage of the drugs was significantly lower. When analysing target doses of pathogenic drugs, the gradations of achieved doses were evenly distributed throughout the entire range of(GFR).

Conclusion. (GFR)<60 ml/min/1.73 m2 occurs in every 3rd patient with CHF in the whole range of LVEF. Decreased(GFR) worsens the prognosis of patients with both CHFlFV and CHFpFV, increasing in direct proportion with the severity of the stage of chronic kidney disease. Inclusion of patients in the surveillance programme within the framework of the CHF service makes it possible to significantly approach the current treatment to the optimal drug therapy, at the same time, certain efforts are required to overcome the difficulties with titration to target dosages.