Epidemiology and Importance of Renal Dysfunction in Heart Failure Patients

Abstract

Renal dysfunction (RD) is a frequent comorbid condition and a major determinant of outcomes in patients with heart failure (HF). It is likely that the etiology of RD in patients with HF is much more complex than we first thought and represents a matrix of independent, albeit interacting, pathophysiological pathways with effects on both the kidney and the heart that share a common denominator: aging and inflammation. Renal dysfunction in HF has been attributed, among others, to biochemical, hormonal, and hemodynamic factors, coupled with pharmacological interventions. Regardless of the cause, the development of RD or worsening renal function is common in patients with HF, and is associated with increased morbidity and mortality. There is increasing evidence, however, that transient increases in creatinine in the setting of acute HF are not prognostically important, whereas persistent deterioration does portend a higher mortality in this patient population. In addition, congestion seems to play an important role in the course of renal deterioration, and the combination of congestion and worsening renal function is the most significant clinical prognosticator in HF patients. This review aims to provide an update on the epidemiology and prognostic significance of RD in HF patients, in both the acute and the chronic setting.

Inhibition of Soluble Epoxide Hydrolase Does Not Improve the Course of Congestive Heart Failure and the Development of Renal Dysfunction in Rats With Volume Overload Induced by Aorto-Caval Fistula

“…Despite the recent therapeutical advances, the prognosis of CHF still remains poor (Dickstein et al 2008, Katz 2003, Roger 2013. Development of renal dysfunction in the context of CHF due to impairment of renal hemodynamics and sodium excretion (Braam et al 2014, Giamouzis et al 2013) is associated with markedly increased risk of death (Ronco et al 2008). Therefore, exploration of pathophysiological mechanisms and examination of novel therapeutical approaches targeting renal dysfunction in CHF are needed to improve prognosis.…”

Cardiorenal Interactions in Acute Decompensated Heart Failure: Contemporary Concepts Facing Emerging Controversies

“…An increase of >0.3 mg/dl in serum creatinine level and a reduction of >20-25% in eGFR are among the most commonly used definitions for WRF in this setting, although it has been suggested that even a smaller increase in serum creatinine (i.e. 0.1 mg/dl) can be associated with worse outcomes (5)(6)(7). Using these definitions, the incidence of acute cardiorenal syndrome has been reported to be around 25 to 30% (8)(9).…”

“…various definitions can be used to define WRF, most studies so far have either used an increase in serum creatinine level of >0.3 mg/dl or a decrease of 20-25% in eGFR(5)(6)(7)(8)(9). Due to the fact that renal function calculated through eGFR does not have a linear relationship with the serum creatinine, it might be speculated that these two definitions of WRF could result in selection of significantly different patient populations.…”

Prevalence, correlative and statistical relationships of renal dysfunction in patients with chronic ischemic heart failure

“…У свою чергу, серцево-судинні захворювання є незалежним чинником ризику розвитку ХХН. Раннє виявлення і ліку-вання патології нирок сповільнює або запобігає розвитку важкої ниркової недостатності, що потребує замісної нир-кової терапії, а також серцево-судинної захворюваності та смертності [9]. Незважаючи на те, що нині у більшості національних рекомендацій визнано несприятливий вплив порушення функції нирок на перебіг ХСН, поширеність ХХН серед хворих на ХСН вивчено недостатньо.…”

“…У деяких дослідженнях описано більшу поширеність ХХН серед жінок, які хворі на ХСН; найсуттєвіші відмінності за статтю відзначають у осіб, які старші за 45 років, що пояснюється зниженням нефропротективної дії естрогенів у постменопа-узальному періоді [6]. Наші результати збігаються з даними, котрі отримали дослідники з інших країн [6,9].…”