rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2016-12-2-138-146rpcardio-1224Research ArticleORIGINAL STUDIESОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯCARDIORENAL INTERACTION IN DECOMPENSATED CHRONIC HEART FAILUREКАРДИОРЕНАЛЬНЫЕ ВЗАИМОДЕЙСТВИЯ ПРИ ДЕКОМПЕНСАЦИИ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИКобалаваЖ. Д.KobalavaZh. D.

Кобалава Жанна Давидовна – доктор медицинских наук, профессор, заведующий кафедрой пропедевтики внутренних болезней РУДН, заведующий кафедрой внутренних болезней, кардиологии и клинической фармакологии факультета повышения квалификации медицинских работников РУДН

marinaef56@mail.ruВиллевальдеС. В.VillevaldeS. V.

Виллевальде Светлана Вадимовна – доктор медицинских наук, доцент, профессор кафедры пропедевтики внутренних болезней РУДН 

marinaef56@mail.ruЕфремовцеваМ А.EfremovtsevaM. A.

Ефремовцева Марина Алексеевна – кандидат медицинских наук,  доцент кафедры пропедевтики внутренних болезней РУДН

marinaef56@mail.ruРоссийский университет дружбы народов, МоскваРоссияPeoples’ Friendship University of Russia, MoscowRussian Federation201604052016122138146Copyright © Kobalava Z.D., Villevalde S.V., Efremovtseva M.A., 20162016Кобалава Ж.Д., Виллевальде С.В., Ефремовцева М.А.Kobalava Z.D., Villevalde S.V., Efremovtseva M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/1224

Aim. To investigate the prevalence of cardiorenal interactions, predictors of development, variants of clinical course, and outcomes of acute kidney injury (AKI) in patients with acute decompensation of chronic heart failure (ADCHF).Material and methods. Patients (n=278) with clinical manifestations of ADCHF were included into the study. All patients underwent clinical, laboratory and instrumental investigation. Renal function was assessed using the CKD-EPI formula to calculate glomerular filtration rate (GFR). Hydration was assessed using the bioimpedance analyzer ABC-01 "Medass" (Russia). Chronic kidney disease (CKD) and AKI were diagnosed according to the criteria of the latest Russian and international guidelines. Six phenotypes of AKI were identified: outpatient and hospital acquired, transient and persistent, de novo, and on the background of CKD.Results. CKD was detected in 125 (45%) patients. AKI developed in 121 (43.5%) patients, and in 52.9% of cases was nosocomial, in 53.7% transient and in 52.1% of cases occurred in patients without history of CKD. The risk of in-hospital mortality compared with patients without AKI significantly increased only in patients with nosocomial AKI (14.1 and 3.8%, p<0.05), AKI de novo (14.3 and 3.85%, p <0.05) and persistent (25 and 3.8%, p<0.001). Patients with these variants of AKI as compared to patients without AKI had more pronounced hydration, as well as less frequent prescription of loop diuretics and beta-blockers during outpatient treatment.Conclusion. The high rate (67.6%) of cardiorenal interactions was found out in patients admitted to hospital with ADCHF. Unfavorable prognostic phenotypes of AKI were hospital acquired, persistent AKI and AKI de novo. Patients with these phenotypes had a more pronounced hydration and inadequate outpatient therapy.

Цель. Изучить распространенность кардиоренальных взаимосвязей, предикторов развития, вариантов течения и исходов острого повреждения почек (ОПП) у больных с острой декомпенсацией хронической сердечной недостаточности (ОДХСН).Материал и методы. В исследование были включены 278 человек с клиническими проявлениями ОДХСН. Всем пациентам проводилось общеклиническое лабораторно-инструментальное обследование. Для оценки функционального состояния почек рассчитывали скорость клубочковой фильтрации (СКФ) по формуле CKD-EPI. Гидратацию оценивали с помощью биоимпедансного анализатора АВС-01 «Медасс» (Россия). Хроническую болезнь почек (ХБП) и ОПП диагностировали на основании критериев последних российских и международных рекомендаций. Выделяли 6 фенотипов ОПП: внебольничное и госпитальное, транзиторное и персистирующее, de novo и на фоне ХБП.Результаты. ХБП была выявлена у 125 (45%) пациентов. ОПП развилось у 121 (43,5%) пациентов, в 52,9% случаев оно было госпитальным, у 53,7% носило транзиторный характер и в 52,1% встречалось у больных без анамнеза ХБП. Риск внутрибольничной смертности по сравнению с пациентами без ОПП достоверно увеличивался только у больных с госпитальным ОПП (14,1 и 3,8%, p<0,05), ОПП de novo (14,3 и 3,85%, p<0,05) и персистирующим (25 и 3,8%, p<0,001). Больные с этими вариантами ОПП отличались от пациентов без ОПП более выраженной гидратацией, а также меньшей частотой назначения петлевых диуретиков и бета-блокаторов на амбулаторном этапе.Заключение. Установлена высокая (67,6%) частота кардиоренальных взаимодействий у пациентов, госпитализированных с ОДХСН. Прогностически неблагоприятными вариантами ОПП являются госпитальное, персистирующее ОПП и ОПП de novo. Пациенты с данными фенотипами характеризуются более выраженной гидратацией и неадекватной амбулаторной терапией.

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The authors declare that there are no conflicts of interest present.