Reversibility of chronic heart failure symptoms in chronic kidney disease patients
Abstract
Aim. To investigate reversibility of clinical symptoms, plus structural and functional myocardial changes in chronic heart failure (CHF) and terminal chronic kidney disease (CKD) patients, before dialysis and in the first year of programmed hemodialysis.
Material and methods. In total, 65 patients with Stage IV-V CKD (NKF, 2002) – 29 men, 36 women, mean age 43,1±11,1 years – underwent clinical and echocardiography examination, according to the national guidelines on CHF diagnostics and management (2003).
Results. According to clinical and functional data, CHF at pre-dialysis CKD stage was diagnosed in 56 patients (86,2%): Stage I – in 19 (33, 9%), IIA in 28 (50,0%), and IIB – in 9 (16,1%). During the first year of programmed hemodialysis, CHF diagnosis was rejected in 14 individuals (25%), and confirmed in 42 (75%): Stage I – in 22 (52,4%), Stage IIA – in 17 (40,5%), and stage IIB – in 3 (7,1%). In all patients, CHF manifested in diastolic myocardial dysfunction, in some – in its combination with systolic dysfunction (16,1% and 7,1% – before dialysis and during its first year, respectively). During the first year of hemodialysis, CHF incidence reduced by 21,6%, reaching 64,6%. Stage I CHF became prevalent, with IIA and IIB Stage prevalence reduction by 1,2 and 2,3 times, respectively.
Conclusion. Reversibility of main CHF symptoms in CKD patients points to the need for timely diagnostics and adequate control of cardiac complication risk factors. Kidney cardiopathy severity criteria should be used for assessing CKD treatment adequacy and choosing the optimal time for starting programmed hemodialysis.
Material and methods. In total, 65 patients with Stage IV-V CKD (NKF, 2002) – 29 men, 36 women, mean age 43,1±11,1 years – underwent clinical and echocardiography examination, according to the national guidelines on CHF diagnostics and management (2003).
Results. According to clinical and functional data, CHF at pre-dialysis CKD stage was diagnosed in 56 patients (86,2%): Stage I – in 19 (33, 9%), IIA in 28 (50,0%), and IIB – in 9 (16,1%). During the first year of programmed hemodialysis, CHF diagnosis was rejected in 14 individuals (25%), and confirmed in 42 (75%): Stage I – in 22 (52,4%), Stage IIA – in 17 (40,5%), and stage IIB – in 3 (7,1%). In all patients, CHF manifested in diastolic myocardial dysfunction, in some – in its combination with systolic dysfunction (16,1% and 7,1% – before dialysis and during its first year, respectively). During the first year of hemodialysis, CHF incidence reduced by 21,6%, reaching 64,6%. Stage I CHF became prevalent, with IIA and IIB Stage prevalence reduction by 1,2 and 2,3 times, respectively.
Conclusion. Reversibility of main CHF symptoms in CKD patients points to the need for timely diagnostics and adequate control of cardiac complication risk factors. Kidney cardiopathy severity criteria should be used for assessing CKD treatment adequacy and choosing the optimal time for starting programmed hemodialysis.
About the Authors
V. V. Belov
Chelyabinsk State Medical Academy, Chelyabinsk
Russian Federation
Russian Federation
O. E. Ilyicheva
Chelyabinsk State Medical Academy, Chelyabinsk
Russian Federation
Russian Federation
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Review
For citations:
Belov V.V., Ilyicheva O.E. Reversibility of chronic heart failure symptoms in chronic kidney disease patients. Cardiovascular Therapy and Prevention. 2007;6(1):68-72. (In Russ.)
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