Possibilities of diagnosing acute renal injury in patients with acute decompensation of chronic heart failure: duplex scanning of the renal arteries


DOI: https://dx.doi.org/10.18565/therapy.2019.1.95-102

Nasonova S.N., Zhirov I.V., Ledyakhova M.V., Andreevskaya M.V., Bogiyeva R.M., Saidova M.A., Tereshchenko S.N.

National Medical Research Center for Cardiology, Moscow
Early diagnosis of acute kidney injury (AKI) is an urgent problem in acute decompensation of chronic heart failure (ADHF).
The aim was to study the features of cardiorenal syndrome in patients with acute decompensation of chronic heart failure with reduced systolic function, and assess the possibility of diagnosing acute renal injury by duplex scanning of the renal arteries. Material and Methods. The objects were 60 patients (62,0±11,1 years) with ADHF (BNP more than 500 pg/ml) and reduced left ventricular ejection fraction (LV 27,05% [23,25; 32, 75]), NYHA FC III–IV. All patients has undergone 6-minute walk test (T6MH), transthoracic echocardiography, creatinine, urea, GFR, albumin, total protein, NT-proBNP, duplex scanning of the renal arteries with assessment of renal hemodynamics (peak systolic (Vps, cm/s), end-diastolic (Ved, cm / s) arterial blood flow velocity, the level of the index is resistive Nost RI=(Vps-Ved)/Vps). Results. AKI is determined based on changes in serum creatinine concentration or diuresis value. Patients with ADHF showed reduced levels of the terminal diastolic blood flow velocity in the renal arteries, detected by duplex scanning, and increased resistance index. Correlations between the parameters of renal hemodynamics, indicators of renal function and NT-proBNP blood concentration have been revealed. A univariate regression analysis showed that RI>0,805 is associated with an increase in risk of AKI of 5,7 times. Conclusion. Acute kidney damage develops in 48,3% of patients hospitalized with acute decompensation of chronic heart failure. Patients with a history of chronic kidney disease had a higher risk of nosocomial AKI. For early diagnosis of AKI in patients with ADHF, it is recommended in addition to creatinine level and calculating GFR to perform a duplex scanning of renal arteries to reveal reduced terminal diastolic blood flow velocity and increased resistance index.
Keywords: duplex scanning of the renal arteries, cardiorenal syndrome type I, acute decompensation of the heart failure, acute renal damage
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Literature


  1. Chioncel O., Mebazaa A., Harjola V.P., Coats A.J., Piepoli M.F. et al. Clinical phenotypes and outcome of patients hospitalized for acute heart failure: the ESC Heart Failure Long-Term Registry. ESC Heart Failure Long-Term Registry Investigators. Eur J Heart Fail. 2017; 19(10): 1242–54. DOI:10.1002/ejhf.890

  2. Logeart D., Isnard R., Resche-Rigon M., Seronde M.F., de Groote P. et al. Heart Failure of the French Society of Cardiology. Current aspects of the spectrum of acute heart failure syndromes in a real-life setting: the OFICA study. Eur J Heart Fail. 2013; 15: 465–76.

  3. Panduranga P., Sulaiman K., Al-Zakwani I., Alazzawi A.A., Abraham A. et al. Demographics, clinical characteristics, management, and outcomes of acute heart failure patients: observations from the Oman Acute Heart Failure Registry. Oman Med J. 2016; 31(3): 188–95. DOI:10.5001/omj.2016.37

  4. Harjola V.P., Follath F., Nieminen M.S., Brutsaert D., Dickstein K. et al. Characteristics, outcomes, and predictors of mortality at 3 months and 1 year in patients hospitalized for acute heart failure. Eur J Heart Fail. 2010; 12: 239–48.

  5. Maggioni A.P., Dahlström U., Filippatos G., Chioncel O., Leiro M.C. et al. Heart Failure Association of ESC (HFA). EURObservational Research Programme: the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail. 2010; 12(10): 1076–84. DOI: 10.1093/eurjhf/hfq154

  6. Parenica J., Spinar J., Vitovec J., Widimsky P., Linhart A. et al. Long-term survival following acute heart failure: The Acute Heart Failure Database – Main registry (AHEAD Main). Eur J Intern Med. 2013; 24:151–60.

  7. Bader F.M., Attallah N. Insights into cardiorenal interactions in acute decompensated heart failure. Curr Opin Cardiol. 2017; 32(2): 203–08. DOI: 10.1097/HCO.0000000000000378

  8. Терещенко С.Н., Жиров И.В., Насонова С.Н., Николаева О.А., Ледяхова М.В. Патофизиология острой сердечной недостаточности. Что нового? Российский кардиологический журнал. 2016; 9(137): 52–64. DOI: 10.15829/1560-4071-2016-9-52-64

  9. Жиров И.В., Терещенко С.Н. Место серелаксина в лечении острой сердечной недостаточности: от уменьшения симптоматики к улучшению прогноза. Евразийский кардиологический журнал. 2015; 3: 32–37.

  10. Chawla L.S., Amdur R.L., Shaw A.D., Faselis C., Palant C.E., Kimmel P.L. Association between AKI and long-term renal and cardiovascular outcomes in United States veterans. Clin J Am Soc Nephrol. 2014; 9:448-56.

  11. Wu V.C., Wu C.H., Huang T.M., Wang C.Y., Lai C.F., Shiao C.C. et al. Long-term risk of coronary events after AKI. J Am Soc Nephrol. 2014; 25:595–605.

  12. Odutayo A., Wong C.X., Farkouh M., Altman D.G., Hopewell S., Emdin C.A. et al. AKI and long-term risk for cardiovascular events and mortality. J Am Soc Nephrol. 2016; pii: ASN.2016010105.

  13. Piccinni P., Cruz D.N., Gramaticopolo S., Garzotto F., Dal Santo M. , Aneloni G. , Rocco M., Alessandri E., Giunta F., Michetti V., Iannuzzi M., Belluomo Anello C., Brienza N., Carlini M., Pelaia P., Gabbanelli V., Ronco C. Prospective multicenter study on epidemiology of acute kidney injury in the ICU: a critical care nephrology Italian collaborative effort (NEFROINT). Minerva Anestesiologica 2011; 77(11): 1072–83.

  14. McCullough P.A., Kellum J.A., Mehta R.L., Murray P.T., Ronco C. ADQI Consensus on AKI biomarkers and cardiorenal syndromes. Contrib Nephrol. 2013; 182: 99–116. DOI: 10.1159/000349969

  15. Рекомендации по ведению пациентов с острой сердечной недостаточностью на догоспитальном и госпитальном этапах оказания медицинской помощи (часть 2). Неотложная кардиология, 2017; 13(1): 34–59.

  16. Prins K., Thenappan T., Markowitz J., Pritzker M. Cardiorenal syndrome type 1: renal dysfunction in acute decompensated heart failure. J Clin Outcomes Manag. 2015; 22: 443–454.

  17. Jentzer J.C., Chawla L.S. A Clinical approach to the acute cardiorenal syndrome. Crit Care Clin. 2015 Oct; 31(4): 685–703. DOI:10.1016/j.ccc.2015.06.006.

  18. Shirakabe A., Hata N., Kobayashi N., Okazaki H., Matsushita M. et al. Worsening renal function definition is insufficient for evaluating acute renal failure in acute heart failure. ESC Heart Fail. 2018; 5(3): 3222–331. DOI:10.1002/ehf2.12264.

  19. Janssens U., Joannidis M. Acute cardiorenal syndromes. Med Klin Intensivmed Notfmed. 2016; 111(4): 341–58. doi: 10.1007/s00063-016-0159-7. Epub 2016 May 10.

  20. Virzì G.M., Torregrossa R., Cruz D.N., Chionh C.Y., de Cal M. et al. Cardiorenal syndrome type 1 may be immunologically mediated: a pilot evaluation of monocyte apoptosis. Cardiorenal Med. 2012; 2(1): 33–42. DOI: 000335499.

  21. Shyam R., Patel M.L., Sachan R., Kumar S., Pushkar D.K. Role of urinary neutrophil gelatinase-associated lipocalin as a biomarker of acute kidney injury in patients with circulatory shock. Indian J Crit Care Med. 2017 Nov; 21(11): 740–45. DOI: 10.4103/ijccm.IJCCM_315_17.

  22. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. European Heart Journal 2012; 33: 1787–1847.

  23. Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр). Сердечная недостаточность. 2013; 81(7): 379–472.

  24. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012; 2: 1–126.

  25. Клинические практические рекомендации KDIGO 2012 по диагностике и лечению хронической болезни почек. Нефрология и диализ 2017; 1: 22–206.

  26. Zhou Q., Zhao C., Xie D., Xu D., Bin J. et al. Acute and acute-on-chronic kidney injury of patients with decompensated heart failure: impact on outcomes. BMC Nephrol. 2012; 13: 51. DOI: 10.1186/1471-2369-13-51.

  27. Vandenberghe W., Gevaert S., Kellum J.A., Bagshaw S.M. et al. Acute kidneyi in cardiorenal syndrome type 1 patients: a systematic review and meta-analysis. Cardiorenal Med. 2016; 6(2): 116–28. DOI: 10.1159/000442300.

  28. Thind G.S., Loehrke M., Wilt J.L. Acute cardiorenal syndrome: Mechanisms and clinical implications. Cleve Clin J Med. 2018; 85(3): 231–39. DOI: 10.3949/ccjm.85a.

  29. Yang C.H., Chang C.H., Chen T.H., Fan P.C., Chang S.W., Chen C.C. et al. Combination of urinary biomarkers improves early detection of acute kidney injury in patients with heart failure. Circ J. 2016; 80(4):1017-23. DOI: 10.1253/circj.CJ-15-0886.

  30. Практическое руководство по ультразвуковой диагностике. Общая ультразвуковая диагностика. Под ред. В.В. Митькова. М: Видар, 2011, 712 с.


About the Autors

Svetlana N. Nasonova, MD, PhD, senior researcher of the Department of myocardial diseases and heart failure, Federal State budgetary organization «National medical research Center for cardiology» of the Ministry of Healthcare of the Russian Federation. Address: 121552, Moscow, 15A 3th Cherepkovskaya str. E-mail: dr.nasonova@mail.ru
Igor V. Zhirov, MD, PhD, leading researcher of the Department of myocardial diseases and heart failure, Federal State budgetary organization «National medical research Center for cardiology» of the Ministry of Healthcare of the Russian Federation. Address: 121552, Moscow, 15A 3th Cherepkovskaya str.
E-mail: izhirov@mail.ru
Maria V. Ledyakhova, postgraduate student of the Department of myocardial diseases and heart failure, Federal State budgetary organization «National medical research Center for cardiology» of the Ministry of Healthcare of the Russian Federation. Address: 121552, Moscow, 15A 3th Cherepkovskaya str.
E-mail: mary06_90@mail.ru
Marina A. Saidova, professor, MD, PhD, professor, head of the Department of ultrasound research methods, Federal State budgetary organization «National medical research Center for cardiology» of the Ministry of Healthcare of the Russian Federation. Address: 121552, Moscow, 15A 3th Cherepkovskaya str.
E-mail: m.saidova@gmail.com
Marina V. Andreevskaya, MD, PhD, junior researcher of the Department of ultrasound research methods, Federal State budgetary organization «National medical research Center for cardiology» of the Ministry of Healthcare of the Russian Federation. Address: 121552, Moscow, 15A 3th Cherepkovskaya str.
E-mail: marineracrim@mail.ru
Roxana M. Bogiyeva, MD, PhD, doctor of the Department of ultrasound research methods, Federal State budgetary organization «National medical research Center for cardiology» of the Ministry of Healthcare of the Russian Federation. Address: 121552, Moscow, 15A 3th Cherepkovskaya str. E-mail: roksuta76@gmail.com
Sergey N. Tereshchenko, professor, MD, PhD, first deputy General Director for scientific work, head of the Department of myocardial diseases and Heart Failure. Federal State budgetary organization «National medical research Center for cardiology» of the Ministry of Healthcare of the Russian Federation.
Address: 121552, Moscow, 15A 3th Cherepkovskaya str. E-mail: tereschenko@yandex.ru

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