European Journal of Molecular & Clinical Medicine

Abstract

Purpose. To identify prognostic factors for the development of renal dysfunction (RD) and to develop a method for
assessing and predicting RD in patients with chronic heart failure (CHF).
Methods. A total of 101 patients with functional class I-III (FC) CHF (according to the classification of the New
York Heart Association) were examined. Also, the patients were divided, depending on the glomerular filtration
rate, determined by the calculation method according to the CKD-EPI formula (eGFR), into two groups: patients
with eGFR≥90 ml / min (n = 20), with eGFR <90 ml / min (n = 81). All patients were determined: creatinine (Cr),
eGFR according to the CKD-EPI formula, albumin / creatinine (Al / Cr) level (mg / mmol) in morning urine,
specific gravity in morning urine portion (SG); studied renal blood flow according to Doppler sonography at the
level of the common left and right renal arteries. To assess the significance of signs for determining and predicting
RD in CHF, we used a method based on Wald's sequential statistical analysis with the development of differential
diagnostic tables, determination of diagnostic coefficients (DC) and information content (J) of each sign in groups of
patients with CHF, depending on the level eGFR, determination of diagnostic thresholds (amount of DC).
Results. As a result of the developed differential diagnostic tables, the most informative signs were identified that
determine the unfavorable prognosis of RD in patients with CHF: creatinine above 80 μmol / l, eGFR less than 90
ml / min, Al / Cr ratio in morning urine more than 3.4 mg / mmol, urine specific gravity SG less than 1015,
resistance index (RI) at the level of the right and left renal arteries more than 0.7. The sum of DCs of these signs,
depending on the severity of symptoms, determines the risk of developing RD: a very high risk in the range from
+15 to +32, high risk - from +8 to +14, moderate risk - from +7 to +3, favorable course of CHF - from 0 to +2
points.
Conclusion. Signs of an unfavorable prognosis for the development of RD in patients with CHF were determined:
creatinine above 80 μmol / l, eGFR less than 90 ml / min, Al / Cr ratio in morning urine more than 3.4 mg / mmol, urine SG less than 1015, RI at the renal level arteries more than 0.7.