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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Abstract
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.
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