THE INVOLVEMENT OF KIDNEYS IN PATIENTS WITH CHRONIC HEART FAILURE ISCHEMIC ETIOLOGY AND LIVER STEATOSIS
About the author:
Khaniukov O. O., Sapozhnychenko L. V., Smolyanova O. V., Kovtun O. V., Doroshenko A. M.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
The aim of the work is to assess the functional condition of the kidneys in patients with chronic heart failure (CHF) of ischemic etiology and liver steatosis. Object and methods. 66 patients with CHF were examined, the main etiological factor of which were ischemic heart disease and arterial hypertension. The diagnosis of heart failure was established on the basis on the level of the N-terminal Brain pro-natriuretic peptide and echocardiography with determination of the ejection fraction (EF) of the left ventricle (LV). The severity of the clinical condition of CHF and the functional status of the patient were assessed. All patients underwent clinical and biochemical sampling, electrocardiography, ultrasound of the liver. The glomerular filtration rate (GFR) was calculated using the MDRD formula and the stage of chronic kidney disease (CKD) was determined; NAFLD Fibrosis SCORE (NFS) was used to assess the presence of liver fibrosis. Results. It was found that the majority of patients (45.5%) had 2 stage of CKD, 7 (10.6%) – stage 1, 15 (22.7%) – 3a and 12 (21.2%) – 3b. Mean GFR was 62.9±18.3 ml/min/1.73 m². According to NFS data, 21.2% of patients with CHF had a high probability of liver fibrosis (F3-F4), 57.6% had an intermediate value and 21.2% did not have severe fibrosis (F0-F2). All patients had ultrasonic signs of liver steatosis. NYHA I functional class (FC) was present in 10 patients, NYHA II – in 25 patients, NYHA III – in 31 patients. It was found that with an increase in the scores on the SCAHF and FC of NYHA, GFR decreases and the stage of CKD increases (p<0.001). In the correlation analysis was obtained a direct relationship between GFR and LVEF (r = 0.27; p <0.05). It was found that while increasing NFS GFR decrease (r = -0.46; p <0.001) and the CKD stage increases (r = 0.50; p <0.001). Conclusions. Shown that with increasing scores for the SCAHF, FC CHF, an indicator of the possibility of liver fibrosis NFS, GFR decreases (r = -0.46; p <0.001) and the stage of CKD increases (r = 0.50; p <0.001). Early finding of renal involvement in patients with heart failure and non-alcoholic fatty liver disease would help to select patients for more thorough follow-up and the selection of optimal therapy.
chronic heart failure, chronic kidney disease, liver steatosis, NAFLD Fibrosis SCORE.
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 2 (156), 2020 year, 174-178 pages, index UDK 616.12-005.4-008.46-036.1+616.36-003.826:616.61-008.6-07