Vojnosanitetski pregled 2012 Volume 69, Issue 10, Pages: 840-845
https://doi.org/10.2298/VSP1210840S
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Prevalence of renal dysfunction and its influence on functional capacity in elderly patients with stable chronic heart failure
Stanojević Dragana (Clinic for Cardiovascular Diseases, Clinical Center Niš, Niš)
Apostolović Svetlana (Clinic for Cardiovascular Diseases, Clinical Center Niš, Niš)
Janković-Tomašević Ružica (Clinic for Cardiovascular Diseases, Clinical Center Niš, Niš)
Šalinger-Martinović Sonja (Clinic for Cardiovascular Diseases, Clinical Center Niš, Niš)
Pavlović Milan (Clinic for Cardiovascular Diseases, Clinical Center Niš, Niš)
Živković Milan (Clinic for Cardiovascular Diseases, Clinical Center Niš, Niš)
Božinović Nenad (Clinic for Cardiovascular Diseases, Clinical Center Niš, Niš)
Kutlešić-Kurtović Dušanka (Clinic for Cardiovascular Diseases, Clinical Center Niš, Niš)
Bacground/Aim. Chronic heart failure (CHF) is highly prevalent and
constitutes an important public health problem around the world. In spite of
a large number of pharmacological agents that successfully decrease
mortality in CHF, the effects on exercise tolerance and quality of life are
modest. Renal dysfunction is extremely common in patients with CHF and it is
strongly related not only to increased mortality and morbidity but to a
significant decrease in exercise tolerance, as well. The aim of our study
was to investigate the prevalence and influence of the renal dysfunction on
functional capacity in the elderly CHF patients. Methods. We included 127
patients aged over 65 years in a stable phase of CHF. The diagnosis of heart
failure was based on the latest diagnostic principles of the European
Society of Cardiology. The estimated glomerular filtration rate (eGRF) was
determined by the abbreviated Modification of Diet in Renal Disease (MDRD2)
formula, and patients were categorized using the Kidney Disease Outcomes
Quality Initiative (K/DOQI) classification system. Functional capacity was
determined by the 6 minute walking test (6MWT). Results. Among 127 patients,
90 were men. The average age was 72.5 ± 4.99 years and left ventricular
ejection fraction (LVEF) was 40.22 ± 9.89%. The average duration of CHF was
3.79 ± 4.84 years. Ninty three (73.2%) patients were in New York Heart
Association (NYHA) class II and 34 (26.8%) in NYHA class III. Normal renal
function (eGFR ≥ 90 mL/min) had 8.9% of participants, 57.8% had eGFR
between 60-89 mL/min (stage 2 or mild reduction in GFR according to K/DOQI
classification), 32.2% had eGFR between 30-59 mL/min (stage 3 or moderate
reduction in GFR) and 1.1% had eGFR between 15-29 mL/min (stage 4 or severe
reduction in GFR). We found statistically significant correlation between
eGFR and 6 minute walking distance (6MWD) (r = 0.390, p < 0.001), LVEF (r =
0.268, p < 0.05), NYHA class (ς = -0.269, p < 0.05) and age (r = - 0.214, p
< 0.05). In multiple regression analysis only patients’ age was a predictor
of decreased 6MWD < 300 m (OR = 0.8736, CI = 0.7804 - 0.9781, p < 0.05).
Conclusion. Renal dysfunction is highly prevalent in the elderly CHF
patients. It is associated with decreased functional capacity and therefore
with poor prognosis. This study corroborates the use of eGFR not only as a
powerful predictor of mortality in CHF, but also as an indicator of the
functional capacity of cardiopulmonary system. However, clinicians
underestimate a serial measurement of eGFR while it should be the part of a
routine evaluation performed in every patient with CHF, particularly in the
elderly population.
Keywords: heart failure, aged, kidney failure, glomerular filtrationrate, quality of life