Comparative evaluation of the influence of nitrate-central and diuretic-central treatment strategies for acute decompencated heart failure in patients with chronic kidney disease

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K. M. Amosova
I. I. Gorda
A. B. Bezrodnyi
G. V. Mostbauer
Yu. V. Rudenko
A. V. Sablin
N. V. Melnichenko
Yu. O. Sychenko
K. I. Cherniaieva
O.V. Vasylenko
I. V. Prudkiy
I. S. Kovalyova
O. V. Khodakivska
P. O. Lazarev
N. O. Kononenko


The aim – to сonduct a comparative evaluation of the effectiveness of different treatment strategies for «wet and
warm» patients with acute decompensated heart failure (ADHF) with сhronic kidney disease (CKD).
Material and methods. A prospective study involved 141 patients with ADHF aged 38 to 85 years (mean age 66.4±2.2), who were hospitalized sequentially in the cardiology departments during 2012–2014. Among all patients with CKD, glomerular filtration rate < 60 ml/(hr · 1.73 m2) was revealed in 95 patients (67.3 %). Diuretic-central (DC) strategy was chosen in 57, nitrate-central (NC) – in 38 patients.
Results. At admission patients DC and NC groups were comparable regarding the level of NT-proBNP, which was significantly decreased in both groups on day 3 (Р<0.05) and in the NC group compared to DC, this decrease was significantly greater than both day 3 and day of the discharge (P<0.05). Glomerular filtration rate was significantly higher already at day 3 in the NC group (35.7±2.8 ml/min versus 30.4±2.7 ml/min, Р<0.05) and was maintained higher at the discharge (63.2±3.7 ml/min versus 48.1±3.8 ml/min, Р<0.01).
Conclusion. In patients with ADHF with CKD, the nitrate-central strategy, in comparison with diuretic-central, is associated with more pronounced clinical decongestion and less pronounced influence on kidney function.

Article Details


chronic kidney disease, acute decompensated heart failure, lipocalin, gelatinase-associated neutrophils (NGAL), glomerular filtration rate


Adams K., Fonarow G., Emerman C. et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and pre-liminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE) // Amer. Heart J.– 2005.– Vol. 149 (2).– P. 209–216.

Arash Aghel, Shrestha K. et al. Serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) in Predicting Worsening Renal Function in Acute Decompensated Heart Failure // J. Card. Fail.– 2010.– Vol. 16(1).– P. 49–54.

Bueno H., Ross J.S., Wang Y. et al. Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, 1993-2006 // JAMA.– 2010.– Vol. 303.– P. 2141–2147.

Butler J., Kalogeropoulos A. Worsening heart failure hospitalization epidemic we do not know how to prevent and we do not know how to treat! // J. Am. Coll. Cardiol.– 2008.– Vol. 52 (6).– P. 435–437.

Clinical Quality Improvement Network Investigators. Morta­­lity risk and patterns of practice in 4606 acute care patients with congestive heart failure: the relative importance of age, sex, and medical therapy // Arch. Intern. Med.– 1996.– Vol. 156.– P. 1669–1673.

Cooper H.A., Dries D.L., Davis C.E. et al. Diuretics and risk of arrhythmic death in patients with left ventricular dysfunction // Circulation.– 1999.– Vol. 100.– P. 1311–1315.

Cotter G., Moshkovitz Y., Kaluski E. et al. The role of cardiac power and systemic vascular resistance in the pathophysiology and diagnosis of patients with acute congestive heart failure // Eur. J. Heart Fail.– 2003.– Vol. 5.– P. 443–451.

Cuffe M.S., Califf R.M., Adams K.F.J. et al. Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) Investigators. Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial // JAMA.– 2002.– Vol. 287.– P. 1541–1547.

Cowie M.R., Komajda M., Murray-Thomas T. et al., for the POSH Investigators. Prevalence and impact of worsening renal function in patients hospitalized with decompensated heart failure: results of the Prospective Outcomes Study in Heart Failure (POSH) // Eur. Heart J. 2006.– Vol. 27.– P. 1216–1222.

Damman K., Navis G., Voors A.A. et al. Worsening renal function and prognosis in heart failure: systematic review and meta-analysis // J. Card. Fail.– 2007.– Vol. 13.– P. 599–608.

Damman K., van Veldhuisen D.J., Navis G. et al. Urinary neutrophil gelatinase associated lipocalin (NGAL), a marker of tubular damage, is increased in patients with chronic heart failure // Eur. J. Heart Fail.– 2008.– Vol. 10.– P. 997–1000.

Felker G.M., O’Connor C.M., Braunwald E. Loop diuretics in acute decompensated heart failure: necessary? Evil? A necessary evil? // Circ. Heart Fail.– 2009.– Vol. 2.– P. 56–62.

Gheorghiade M., Abraham W., Albert N. et al. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure // J. Am. Med. Assoc.– 2006.– Vol. 296.– P. 2217–2226.

Gheorghiade M., Follath F., Ponikowski P. et al. Assessing and grading congestion in acute heart failure: a scientific statement from the acute heart failure committee of the heart failure association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine // Eur. J. Heart Fail.– 2010.– Vol. 12.(5).– P. 423–433.

Gheorghiade M., Zannad F., Sopko G. et al. Acute heart failure syndromes: current state and framework for future research // Circulation.– 2005.– Vol. 112.– P. 3958–3968.

Hasselblad V., Stough W.G., Shah M.R. et al. Relation between dose of loop diuretics and outcomes in a heart failure population: results of the ESCAPE trial // Eur. J. Heart Fail.– 2007.– Vol. 9.– P. 1064–1069.

Hillege H.L., Nitsch D., Pfeffer M.A. et al. Renal function as a predictor of outcome in a broad spectrum of patients with heart failure // Circulation.– 2006.– Vol. 113.– P. 671–678.

Heywood J. The cardiorenal syndrome: lessons from the ADHERE database and treatment options // Heart. Fail. Rev.– 2004.– Vol. 9 (3).– P. 195–201.

Januzzi J.L., van Kimmenade R., Lainchbury J. et al. NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: The International Collaborative of NT-proBNP Study // Eur. Heart J.– 2006.– Vol. 27 (3).– P. 330–337.

Klein L., O’Connor C.M., Leimberger J.D. et al., for the O-CHFI. Lower Serum Sodium Is Associated With Increased Short-Term Mortality in Hospitalized Patients With Worsening Heart Failure: Results From the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) Study // Circulation.– 2005.– Vol. 111.– P. 2454–2460.

Levey A.S., Coresh J., Balk E. et al. National Kidney Foundation. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification // Ann. Intern. Med.– 2003.– Vol. 139 (7).– P. 605.

Levey A.S., Stevens L.A. et al. A New Equation to Estimate Glomerular Filtration Rate // Ann. Intern. Med.– 2009.–Vol. 150.– P. 604–612.

Lala A., McNulty S.E., Mentz R.J. et al. Relief and Recurrence of Congestion During and After Hospitalization for Acute Heart Failure: Insights From Diuretic Optimization Strategy Evaluation in Acute Decompensated Heart Failure (DOSE-AHF) and Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARESS-HF) // Circ. Heart Fail.– 2015.– Vol. 8 (4).– P. 741–748.

McMurray J.V., Adamopoulos S., Anker S.D. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology // Eur. Heart J.– 2012.– Vol. 33.– P. 1787–1847.

Mehta R.L., Kellum J.A., Shah S.V. et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury // Crit. Care.– 2007.– Vol. 11.– P. 31.

Mishra J., Ma Q., Prada A. et al. Identification of neutrophil gelatinase-associated lipocalin as a novel early urinary bio­­marker for ischemic renal injury // J. Am. Soc. Nephrol.– 2003.– Vol. 14.– P. 2534–2543.

Mullens W., Abrahams Z., Francis G.S. et al. Sodium nitroprusside for advanced low-output heart failure // J. Am. Coll. Cardiol.– 2008.– Vol. 52.– P. 200–207.

Mullens W., Abrahams Z., Francis G.S. et al. Importance of venous congestion for worsening of renal function in advanced decompensated heart failure // J. Am. Coll. Cardiol.– 2009.– Vol. 53.– P. 589–596.

Nelson G., Silke B., Ahuja R., Hussain M. Haemodynamic advantages of isosorbide dinitrate over frusemide in acute heart failure following myocardial infarction // Lancet.– 1983.– Vol. 1 (8327).– P. 730–732.

Panagopoulou V., Deftereos S., Kossyvakis C. et al. NTproBNP: an important biomarker in cardiac diseases // Curr. Top. Med. Chem.– 2013.– Vol. 13 (2).– P. 82–94.

Tavazzi L., Maggioni A.P., Lucci D. et al. Nationwide survey on acute heart failure in cardi ology ward services in Italy // Eur. Heart J.– 2006.– Vol. 27.– P. 1207–1215.

The Criteria Committee of the New York Heart Association. Nomenclature and сriteria for diagnosis of diseases of the heart and great vessels.– 9th ed.– Boston, Mass: Little, Brown & Co; 1994.– P. 253–256.

Van Kimmenade R.R., Januzzi J.L., Baggish A.L. et al. Amino-terminal pro-brain natriuretic peptide, renal function, and outcomes in acute heart failure: redefining the cardiorenal interaction? // J. Am. Coll. Cardiol.– 2006.– Vol. 48.– P. 1621–1617.

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