KIDNEY DAMAGE IN CHRONIC HEART FAILURE

Abstract

Despite the achievements of modern cardiology, chronic heart failure (CHF) is still a prognostically unfavorable condition. Mortality among patients with CHF is 4-8 times higher than in the general population, half of all patients die within 5 years after diagnosis. In patients with CHF of functional class IV (FC), mortality within six months reaches 44%. Heart and kidney lesions are widespread in the population and often coexist, increasing mortality and the risk of complications. The development of renal dysfunction (DP) is one of the most common comorbid conditions with CHF. A decrease in the contractility of the myocardium leads to a deterioration in the functional state of the kidneys, which, in turn, can cause the progression of CHF. DP in CHF may be associated with the addition of concomitant pathology of the kidneys and renal vessels, however, more than two thirds of patients with CHF without concomitant primary kidney pathology have chronic kidney disease (CKD), the prevalence of which among patients with decompensated CHF is 50-70%. DP significantly worsens the prognosis in people with CHF and low left ventricular ejection fraction (LVEF). Randomized studies of SOLVD and SAVE have shown an association between DP and mortality in patients with LV systolic dysfunction. With a decrease in glomerular filtration rate (GFR) <60 ml/min/1.73 m2, the risk of mortality increased by 2.1 times, with reduced LV systolic function – by 3.8 times. It should also be noted that with a pronounced violation of the contractility of the LV myocardium, a decrease in GFR, as a rule, coincides with the appearance of another unfavorable predictor – an increase in the level of natriuretic peptides.