The concurrence of kidney and liver dysfunctions in decompensated heart failure


Cite item

Full Text

Abstract

Aim. To study the incidence, pattern, and predictive factors of concurrent kidney and liver dysfunctions in patients with decompensated heart failure (HF). Subjects and methods. The kidney and liver function indicators were estimated in 322 patients aged 69.5±10.6 years with decompensated HF (hypertension in 87%, myocardial infarction in 57%, atrial fibrillation in 65%, chronic kidney disease in 39%, type 2 diabetes in 42%, a left ventricular ejection fraction (EF) of 38±13%, EF <35% 39%, NYHA Functional Class IV in 56%). Cardiohepatic syndrome (CHS) was diagnosed if at least one indicator of liver function was increased; acute kidney injury (AKI) was diagnosed using the KDIGO criteria. Results. AKI and CHS had been previously diagnosed in 60 (18.6%) and 274 (85.1%) patients, respectively. Among the patients with signs of kidney and/or liver dysfunction, the incidence of isolated CHS, concurrent AKI and CHS, and isolated AKI was 78.4, 20.1, and 1.5%, respectively. The patients with concurrent kidney and liver dysfunctions were observed to have more profound systemic hemodynamic changes (hypoperfusion and congestion). The risk of concurrent AKI and CHS increased glomerular filtration rate (GFR) <45 ml/min/1.73 m2, admission systolic blood pressure <110 mm Hg, needs for vasopressors, hydropericardium, and EF <35%. The concurrence of AKI and CHS was associated with longer hospital stay (15.7±6.5 and 13.5±4.8 days, respectively; p<0.05). Conclusion. The incidence of concurrent AKI and CHS in patients with decompensated HF is 20.1%. Concurrent kidney and liver dysfunctions is associated with more obvious signs of hypoperfusion and congestion and characterized by worse prognosis.

References

  1. Мухин Н.А., Моисеев В.С., Кобалава Ж.Д. Кардиоренальные взаимодействия: клиническое значение и роль в патогенезе заболеваний сердечно-сосудистой системы и почек. Терапевтический архив. 2004;6:39-46.
  2. Кобалава Ж.Д., Виллевальде С.В., Ефремовцева М.А. Основы кардиоренальной медицины. Издательство ГЭОТАР-Медиа; 2014.
  3. Моисеев В.С., Мухин Н.А., Смирнов А.В., Кобалава Ж.Д., Бобкова И.Н., Виллевальде С.В., Ефремовцева М.А., Козловская Л.В., Швецов М.Ю., Шестакова М.В. Сердечно-сосудистый риск и хроническая болезнь почек: стратегии кардио-нефропротекции. Российский кардиологический журнал. 2014;8:7-37.
  4. Ronco C, McCullough P, Anker S, Anand I, Aspromonte N, Bagshaw S, Bellomo R, Berl T, Bobek I, Cruz D, Daliento L, Davenport A, Haapio M, Hillege H, House A, Katz N, Maisel A, Mankad S, Zanco P, Mebazaa A, Palazzuoli A, Ronco F, Shaw A, Sheinfeld G, Soni S, Vescovo G, Zamperetti N, Ponikowski P.. Cardio-renal syndromes: report from the consensus conference of the Acute Dialysis Quality Initiative. Eur Heart J. 2009;31(6):703-711. doi: 10.1093/eurheartj/ehp507.
  5. Vandenberghe W, Gevaert S, Kellum J, Bagshaw S, Peperstraete H, Herck I, Decruyenaere J, Hoste E. Acute Kidney Injury in Cardiorenal Syndrome Type 1 Patients: A Systematic Review and Meta-Analysis. Cardiorenal Med. 2015;6(2):116-128. doi: 10.1159/000442300.
  6. Poelzl G, Auer J. Cardiohepatic Syndrome. Curr Heart Fail Rep. 2014;12(1):68-78. doi: 10.1007/s11897-014-0238-0.
  7. Laribi S, Mebazaa A. Cardiohepatic Syndrome: Liver Injury in Decompensated Heart Failure. Curr Heart Fail Rep. 2014;11(3): 236-240. doi: 10.1007/s11897-014-0206-8.
  8. Samsky M, Patel C, DeWald T, Smith A, Felker G, Rogers J, Hernandez A. Cardiohepatic Interactions in Heart Failure. J Am Coll Cardiol. 2013;61(24):2397-2405. doi: 10.1016/j.jacc.2013.03.042.
  9. Scholfield M, Schabath M, Guglin M. Longitudinal Trends, Hemodynamic Profiles, and Prognostic Value of Abnormal Liver Function Tests in Patients With Acute Decompensated Heart Failure: An Analysis of the ESCAPE Trial. J Cardiac Fail. 2014;20(7):476-484. doi: 10.1016/j.cardfail.2014.05.001.
  10. Samsky M, Dunning A, DeVore A, Schulte P, Starling R, Wilson Tang W, Armstrong P, Ezekowitz J, Butler J, McMurray J, Teerlink J, Voors A, Metra M, Mentz R, O’Connor C, Patel C, Hernandez A. Liver function tests in patients with acute heart failure and associated outcomes: insights from ASCEND-HF. Eur J Heart Fail. 2015. p.n/a-n/a. doi: 10.1002/ejhf.440.
  11. Ambrosy A, Gheorghiade M, Bubenek S, Vinereanu D, Vaduganathan M, Macarie C, Chioncel O. The predictive value of transaminases at admission in patients hospitalized for heart failure: findings from the RO-AHFS registry. Eur Heart J: Acute Cardiovascular Care. 2013;2(2):99-108. doi: 10.1177/2048872612474906.
  12. Nikolaou M, Parissis J, Yilmaz M, Seronde M, Kivikko M, Laribi S, Paugam-Burtz C, Cai D, Pohjanjousi P, Laterre P, Deye N, Poder P, Cohen-Solal A, Mebazaa A. Liver function abnormalities, clinical profile, and outcome in acute decompensated heart failure. Eur Heart J. 2012;34(10):742-749. doi: 10.1093/eurheartj/ehs332.
  13. McCullough P, Kellum J, Haase M, Müller C, Damman K, Murray P, Cruz D, House A, Schmidt-Ott K, Vescovo G, Bagshaw S, Hoste E, Briguori C, Braam B, Chawla L, Costanzo M, Tumlin J, Herzog C, Mehta R, Rabb H, Shaw A, Singbartl K, Ronco C. Pathophysiology of the Cardiorenal Syndromes: Executive Summary from the Eleventh Consensus Conference of the Acute Dialysis Quality Initiative (ADQI). Blood Purif. 2014;37(s2):2-13. doi: 10.1159/000349966.
  14. Shah S, Sass D. Cardiac Hepatopathy: A Review of Liver Dysfunction in Heart Failure. Liver Res Open J. 2015;1(1):1-10. doi: 10.17140/lroj-1-101.
  15. Мареев В.Ю., Агеев Ф.Т., Арутюнов Г.П. и др. Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр). Сердечная недостаточность. 2013;14(7):380-382.
  16. https://www.kidney.org/professionals/kdoqi/gfr_calculator
  17. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Summary of Recommendation Statements. Kidney Int. 2012;Suppl.2(1):8-12. doi: 10.1038/kisup.2012.7.
  18. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Abstract. Kidney Int. 2013;Suppl.3(1):4. doi: 10.1038/kisup.2012.76.
  19. Клименко А.С., Виллевальде С.В., Кобалава Ж.Д. Клинические варианты острого почечного повреждения при декомпенсации хронической сердечной недостаточности: распространенность, тяжесть и исходы. Клиническая нефрология. 2013;5:19-26.
  20. Braunstein J, Anderson G, Gerstenblith G, Weller W, Niefeld M, Herbert R, Wu A. Noncardiac comorbidity increases preventable hospitalizations and mortality among medicare beneficiaries with chronic heart failure. J Am Coll Cardiol. 2003;42(7):1226-1233. doi: 10.1016/S0735-1097(03)00947-1.
  21. Mentz R, Felker G. Non0cardiac Comorbidities and Acute Heart Failure Patients. Heart Fail Clin. 2013;9(3):359-vii. doi: 10.1016/j.hfc.2013.04.003.
  22. van Deursen V, Damman K, van der Meer P, Wijkstra P, Luijckx G, van Beek A, van Veldhuisen D, Voors A. Co-morbidities in heart failure. Heart Fail Rev. 2012;19(2):163-172. doi: 10.1007/s10741-012-9370-7.
  23. van Deursen V, Urso R, Laroche C, Damman K, Dahlström U, Tavazzi L, Maggioni A, Voors A. Co-morbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey. Eur J Heart Fail. 2013;16(1):103-111. doi: 10.1002/ejhf.30.
  24. Testani J, Khera A, St. John Sutton M, Keane M, Wiegers S, Shannon R, Kirkpatrick J. Effect of Right Ventricular Function and Venous Congestion on Cardiorenal Interactions During the Treatment of Decompensated Heart Failure. Am J Cardiol. 2010;105(4):511-516. doi: 10.1016/j.amjcard.2009.10.020.
  25. Testani J, McCauley B, Chen J, Coca S, Cappola Τ, Kimmel S. Clinical Characteristics and Outcomes of Patients With Improvement in Renal Function During the Treatment of Decompensated Heart Failure. J Cardiac Fail. 2011;17(12):993-1000. doi: 10.1016/j.cardfail.2011.08.009.
  26. van Deursen V, Damman K, Hillege H, van Beek A, van Veldhuisen D, Voors A. Abnormal Liver Function in Relation to Hemodynamic Profile in Heart Failure Patients. J Cardiac Fail. 2010;16(1):84-90. doi: 10.1016/j.cardfail.2009.08.002.
  27. Bayraktar U. Hepatic venous outflow obstruction: Three similar syndromes. World J Gastroenterol. 2007;13(13):1912. doi: 10.3748/wjg.v13.i13.1912.
  28. Damman K, Navis G, Smilde T, Voors A, van der Bij W, van Veldhuisen D, Hillege H. Decreased cardiac output, venous congestion and the association with renal impairment in patients with cardiac dysfunction. Eur J Heart Fail. 2007;9(9):872-878. doi: 10.1016/j.ejheart.2007.05.010.
  29. Brisco M, McCauley B, Chen J, Parikh C, Testani J. Biochemical Evidence of Mild Hepatic Dysfunction Identifies Decompensated Heart Failure Patients With Reversible Renal Dysfunction. J Cardiac Fail. 2013;19(11):739-745. doi: 10.1016/j.cardfail.2013.10.005.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2016 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 

Address of the Editorial Office:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Correspondence address:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Managing Editor:

  • Tel.: +7 (926) 905-41-26
  • E-mail: e.gorbacheva@ter-arkhiv.ru

 

 © 2018-2021 "Consilium Medicum" Publishing house


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies