Reduced Albuminuria and Potassemia Indicate Early Renal Repair Processes after Resynchronization Therapy in Cardiorenal Syndrome Type 2

Abstract

Background. Patients with chronic cardiorenal syndrome type 2 (T2-CRS) who qualify for resynchronization therapy (CRT) are exposed perioperatively to potentially nephrotoxic factors including contrast agents and blood loss. Methods. The objective of this prospective interventional study was to assess the effects of CRT on renal function in patients with T2-CRS within the first 48 hours following implantation. Initially, 76 patients (15% female; aged 69 ± 9.56 years) with heart failure (New York Heart Association classes II–IV), ejection fraction ≤ 35%, and QRS > 130 ms were included in the study. During CRT implantation, a nonionic contrast agent (72.2 ± 44.9 mL) was administered. Prior to and 48 hours following implantation, renal function was evaluated using the following serum biomarkers: creatinine (sCr), estimated glomerular filtration rate (using the Chronic Kidney Disease Epidemiology Collaboration equation [eGFRCKD-EPI]), and the electrolyte and urine biomarkers albumin (uAlb), albumin/creatinine ratio (UACR), and neutrophil gelatinase-associated lipocalin (uNGAL). Results. Before CRT, patients classified as NYHA class III or IV had higher uNGAL levels in comparison to uNGAL levels after CRT (43.63 ± 60.02 versus 16.63 ± 18.19; p=0.041). After CRT implantation, uAlb, UACR, and potassium levels were reduced (p<0.05), and uNGAL, sCr, and eGFRCKD-EPI were unchanged. The contrast medium volume did not correlate with the test biomarkers (p>0.05). Conclusions. In patients with T2-CRS, uNGAL is a biomarker of kidney injury that correlates with the NYHA classes. A stable uNGAL value before and after CRT implantation confirms the lack of risk of contrast-induced nephropathy. Reduced albuminuria and blood potassium are biomarkers of improving T2-CRS in the early post-CRT period.

Cardiorenal Syndrome: New Pathways and Novel Biomarkers

“…An example is represented by the reduced levels of potassium and albuminuria, which have been shown to be related to early renal repair processes after cardiac resynchronization therapy (CRT) in CRS Type 2. In a population of 76 patients (15% female; aged 69 ± 9.56 years) with HF (New York Heart Association classes II-IV), the amount of these two biomarkers was reduced after CRT ( p < 0.05), while urinary NGAL, eGFR, and SCr were unvaried [ 16 ].…”

Cardiac Implantable Electronic Devices in Hemodialysis and Chronic Kidney Disease Patients—An Experience-Based Narrative Review

“…Effective left ventricle reverse remodeling plays a vital role in preserving renal function, regardless of the degree of baseline renal insufficiency [27]. Improvement of renal function emphasizes the importance of cardiorenal interaction, providing another mechanistic argument for CRT's beneficial effects [28]. Thus, CRT should be offered to CKD patients, if indicated, as expected benefits outweigh the risks associated with this procedure.…”

Urinary NGAL Measured after the First Year Post Kidney Transplantation Predicts Changes in Glomerular Filtration over One-Year Follow-Up

“…NGAL has been assigned the protective role during acute tubular injury, increasing autophagy in the distal tubular cells, inhibiting apoptosis and inducing regeneration [ 17 , 18 , 19 ]. More recently, NGAL has been studied as a marker of chronic kidney disease (CKD), including diabetic kidney disease [ 20 , 21 ], and as a marker of cardiovascular risk [ 22 , 23 ]. In kidney transplantation, NGAL (measured early post-transplant) has been extensively studied as a predictor of delayed graft function [ 13 , 24 , 25 , 26 ].…”