DYNAMICS OF THE INDICES OF CHRONIC HEART FAILURE IN CHRONIC KIDNEY DISEASE PATIENTS WITH RENAL REPLACEMENT THERAPY

Abstract

THE AIM of the work was to study the dynamics of clinical manifestations of chronic heart failure (CHF) and structural-functional alterations in the myocardium in patients with chronic kidney disease (CKD) at the predialysis stage and during the first year of program hemodialysis. PATIENTS AND METHODS. The work included 65 patients (29 men and 36 women, mean age 43.1±11.1 years) with the IV-V stage CKD (NKF, 2002): the estimation of the findings of clinical and echocardiographic investigations was made at the predialysis stage and during the first year of hemodialysis according to the national recommendations on diagnostics and treatment of CHF (2003). RESULTS. At the predialysis stage of CKD CHF was diagnosed in 56 patients (86.2%): I stage in 19 (33.9%), IIA – in 28 (50.0%), IIB – in 9 (16.1%) patients. During the first year of program hemodialysis the diagnosis of CHF was abolished in 14 patients (25%), in 42 patients (75%) it was confirmed: I stage – in 22 (52.4%), IIA stage – in 17 (40.5%), IIB stage – in 3 (7.1%) patients. In all cases CHF became apparent as a diastolic dysfunction of the myocardium, in some cases – in combination with systolic (16.1% and 7.1% at the predialysis stage and in the first year of hemodialysis respectively). During the first year of renal-substitutive therapy the incidence of CHF was 21.6% less and made up 64.6% of cases. In the structure of CHF the Ist stage was prevailing, the shares of the IIA and IIB became 1.2 and 2.3 times less. CONCLUSION. The reversibility of main manifestations of CHF in patients with renal cardiopathy stresses the necessity of timely detection and adequate correction of risk factors of cardiac complications. It is expedient to use the criteria of severity of renal cardiopathy in the assessment of adequacy of treatment of CKD for solving the question of timely administration of program hemodialysis.