Gorda I. Renal dysfunction with acute decompensated heart failure.

The dissertation is devoted to the improvement of the effectiveness of stratification of risk and treatment of patients with "warm and wet" acute decompensated heart failure (ADHF) with renal dysfunction by determining the clinical significance of chronic kidney disease (CHD) and various variants of deterioration of renal function, as well as comparative evaluation of the effectiveness and safety of various strategies of drug therapy.The work is based on a prospective and retrospective survey of 357 patients with acute decompensated heart failure who were hospitalized in the department of cardiological resuscitation or cardiology departments of the Alexander Clinical Hospital in Kyiv. For the retrospective part of the study, there were 216 patient history histories, in the prospective study included 141 patients who were successively hospitalized for the "warm-wet" ADHF with appropriate inclusion / non-inclusion criteria and informed consent to participate in the study.According to our study, in the "warm and wet" patients with ADHF, the CKD is associated with a greater severity of the clinical signs of congestion and its cardiac performance - E/E' (30 %) and NT-proBNP (28 %) as at the time of hospitalization, and at the time of discharge (24.5 and 38.8 % respectively), despite a larger total dose of furosemide for the first 5 days (30 %), as well as an elevated level of NGAL, compared to patients with glomerular filtration rate of 60 ml/min/1.73 m? or more both in the first day and on the day of the discharge (respectively by 36.5 and 18.6 %).Patients with worsening renal function (WRF) differed from patients without WRF with a higher incidence of hypertension, diabetes and post-infarction cardiosclerosis in history (all p <0.05). Patients with stable WRF were significantly older than their age compared to patients without WRF (72.1 ± 4.2 vs. 57.7 ± 2.9, p <0.01).Patients with GFR <60 and WRF were significantly higher in patients with both GFR groups ?60 (p<0.05-0.01) and had a higher incidence of hypertension, diabetes mellitus and post-infarction cardiosclerosis compared to patients with GFR> 60 without WRF (p<0.05-0.01).In the analysis of data in the dynamics, the level of dyspnea on the Borg scale in the NC group was significantly lower than in the DC group, from the 3rd day of treatment, which was maintained at the time of discharge (p <0.05). The level of the marker of tubular damage (NGAL) did not differ from D1 in patients of both groups. At the time of discharge, NGAL significantly decreased in both groups (p <0.01), compared with D1. At the same time, in the NC group, it was significantly lower than in DC (95.8 ± 11.2 ng/ml vs 109.4 ± 12.5 ng / ml, p <0.01).