Renal function in patients with chronic heart failure and reduced left ventricular ejection fraction depending on clinical and hemodynamic parameters

Main Article Content

L. G. Voronkov
G. Ye. Dudnik
A. V. Lyashenko


The aim – to examine the relationship between parameters of the renal function and main characteristics in patients with chronic heart failure and reduced left ventricular ejection fraction during their clinical and instrumental examination.
Material and methods. The present analysis includes 134 patients and reduced left ventricular ejection fraction with II–IV New York Heart Association (NYHA) classes. All patients were in stable clinical condition. Baseline measurements included height, weight, blood preasure, heart rate, NYHA classification. All patients were examined by routine ECG, echocardiography. Glomerular filtration rate (GFR) was estimated using the CKD-EPI equation. Daily microalbuminuria and urinary albumine/creatinine ratio were determined. Definitions of levels of blood urea nitrogen, uric acid,
interleukin-6, NT-proBNP and citrulin were performed. All patients received standard treatment.
Results. The performed study demonstrated the role of GFR as indicator most closely related to the clinical characte­­ristics of the examined patients (NYHA class, age, hypertension, diabetes, anemia) and levels of interleukin-6 and citrulline. Microalbuminuria level and albumin/creatitine ratio in urine did not show a similar relation, except for the NYHA class. Blood urea nitrogen was higher in patients with higher NYHA class and with concomitant diabetes and anemia. All studied parameters of the renal function revealed a reliable association with uric acid level. There were no significant (P<0.05) relationships between renal function parameters and systolic blood pressure, heart rate, left ventricular ejection fraction and flow-dependent vasodilator response of the brachial artery, as well as the level of NT-proBNP in plasma.
Conclusions. Among stable patients with chronic heart failure and reduced left ventricular ejection fraction, there were significantly lower levels of GFR in patients with III–IV NYHA classes, in older women (≥ 63 years) and in patients with hypertension, diabetes and anemia. The level of GFR was directly related to the level of circulating biomarkers, such as uric acid, interleukin-6 and citrulline. The levels of microalbuminuria, urinary albumine/creatinine ratio, blood urea nitrogen were significantly higher in patients with ІІІ–ІV NYHA classes.

Article Details


Chronic heart failure, renal dysfunction, glomerular filtration rate, microalbuminuria.


Ivanov DD, Korzh OM. Khronichna khvoroba nyrok: diahnostyka ta likuvannia. – Donetsk: Vydavets Zaslavskyi O.Yu., 2014. 56p (in Ukr).

Ivanov DD. Khronichna khvoroba nyrok . Mizhnarodnyi endokrynolohichnyi zhurnal [International endocrinology J.].2005; 2: 67–72.(in Russ).

Mkhitarian LS, Kuchmenko O.B, Yevstratova IN. Tsytrulin yak marker funktsionalnoho stanu orhaniv za umov patolohichnykh staniv. Ukr. kardiol. zhurn. [Ukrainian Journal of Cardiology]2016; 3: 109–115(in Ukr).

Rekomendatsii Asotsiatsii kardiolohiv Ukrainy z diahnostyky ta likuvannia khronichnoi sertsevoi nedostatnosti. K., 2017.

Sirenko YuM, Radchenko HD, Hranich VM. Funktsiia nyrok u khvorykh z arterialnoiu hipertenziieiu: metody doslidzhennia ta stratehichni pidkhody do likuvannia. Ukrainskyi kardiolohichnyi zhurnal [Ukrainian Journal of Cardiology] 2005; 4: 9–17 (in Ukr).

Sirenko YuM. Novi mozhlyvosti vyznachennia mikroalbuminurii v klinichnii praktytsi. Arterrialna hipertenziia [Arterial hipertension]. 2010; 6: 55–57(in Ukr).

Celermajer DS, Sorensen RE, Bull C, Robinson J, Deanfield JE. Endothelium-dependent dilatation in the systemic arteries of asymptomatic subjects relates to coronary risk factors and their interaction. J Am Coll Cardiol 1994; 24 (6): 1468–1474.

Cohn JN. Plasma norepinephrine and mortality.Clin. Cardiol 1995; 18: 9–12.

Damman K, Testani JM, Jeffrey M. The kidney in heart failure: an update. Europ. Heart J 2015; 36: 1437–1444.

Damman K, Valente MA, Voors AA, O'Connor CM, van Veldhuisen DJ, Hillege HL. Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis. Eur.Heart J 2014; 35: 455–469.

Dzau VJ, Colucci WS, Hollenberg NK, Williams GH. Relation of renin-angiotensine-aldosterone system to clinical state in congestive heart failure. Circulation 1981; 63: 645–651.

Francis GS, Benedict C, Johnstone DE, Kirlin PC, Nicklas J, Liang CS. Comprasion of neuroendocrine activation in patients with left ventricular dysfunction with and without congestive heart failure. A substudy of the studies of left ventricular dysfunction (SOLVD). Circulation 1990; 82: 1724–1729.

Gertzel C, Johannes F E, Mann N, Qilong Y. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 2001; 286: 421–426.

Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. New. Engl. J. Med 2004;351: 1296–1305.

Hillege HL, Girbes AR, de Kam PJ, Boomsma F, de Zeeuw D, Charlesworth A, Hampton JR, Veldhuisen D. Renal function, neurohormonal activation, and survival in patients with chronic heart failure. Circulation 2000;102: 203–210.

Jackson CE, Solomon SD, Gerstein HC, Zetterstrand S, Olofsson B, Michelson EL. Albuminuria in chronic heart failure: prevalence and prognostic importance . Lancet 2009;374: 543–550.

Medcalf EA, Newman DJ, Gorman EG, Price CP. Rapid, Robust method for measuring low concentration of albumin in urine. Clin Chem 1999;3: 446–449.

Myers GL, Miller WG, Coresh J, Fleming J, Greenberg N, Greene T, Hostetter T, Levey AS. Reccommtndations for Improving Serum Creatinine Measurement. Clin Chem 2006;52: 5–18.

Nohria A, Hasselblad V, Stebbins A, Pauly DF, Fonarow GC, Shah M, Yancy CW, Califf RM, Stevenson LW, Hill JA. Cardiorenal interactions: insights from the ESCAPE trial. J Am Coll Cardiol 2008; 51: 1268–1274.

Sautin YY, Johnson RJ. Uric acid: the oxidant – antioxidant paradox. Nucleosides Nucleotides Nucleic Acids. 2008; 28: P. 608–619.

Sawyer DB, Wilson SC. Oxidative stress in heart failure in: heart Failure: a companion to Braunvalds Heart disease. Man, 2004.192 p.

Schrier RW. Blood urea nitrogen and serum creatinine: not married in heart failure. Circ. Heart Fail 2008; 1: 2–5.

Smith GL, Lichtman JH, Bracken MB, Shlipak MG, Phillips CO. Renal impairment and outcomes in heart failure: systematic review and meta-analysis. J.Am.Coll. Cardiol 2006; 47(10):1987–1996.

Valentine MA, Damman K, Dunselman PH. Urinary proteins in heart failure. Prog. Cardiovasc. Dis 2012; 55: 44–45.

Veldhuisen DJ, Ruilope LM, Maisel AS, Damman K. Biomarkers of renal injury and funktion: diagnostic, prognostic and theraputic implication in heart failure. Eur. Heart J 2016; 37: 2577–2585.

Tonelli M, Wiebe N, Culleton B, House A, Rabbat C, Fok R. Chronic kidney disease and mortality risk: a systematic revive. J. Am. Soc. Nephrol. 2006; 17: 2034–2047.

Zima, T. Laboratorna diagnostika. Galen, 2002. 1140 p.

Most read articles by the same author(s)

1 2 > >>