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CYSTATIN C – A MARKER OF RENAL AND MYOCARDIAL DYSFUNCTIONS IN PATIENTS WITH ISCHEMIC HEART DISEASE ASSOCIATED WITH INITIAL STAGES OF CHRONIC KIDNEY DISEASE

Authors: Kravchun P.G., Mykhailova Yu.O., Lapsina L.A.

Pages: 331-338

Abstract

  

Introduction. Renal dysfunction in patients with chronic heart failure (CHF) plays a key role as a risk factor and predictor of unfavorable prognosis, marker of increasing the frequency of hospitalizations and deaths. In recent years cystatin C as a marker of early diagnosis of glomerular functions, staging and prognosis of chronic kidney disease (CKD) is often used for assessment of renal function. There are a lot of publications about the role of cystatin C as an independent biomarker of cardiovascular events, including myocardial dysfunction in patients without primary renal impairment.

Our aim was to access the cardiorenal interactions in patients with CHF associated with CKD I–II stage by determining the levels of cystatin C.

Material and Methods. We examined 103 patients with CHF. 58 patients with CHF and CKD comprised group 1; group 2 – 45 patients with CHF without CKD. Serum creatinine was measured by Jaffe-method, the levels of cystatin C – by ELISA, glomerular filtration rate (GFR) was calculated by MDRD formula; also used echocardiography, kidneys ultrasound.

Discussion. We determined the increase of creatinine levels in patients with CHF and CKD in 58 % cases, cystatin C – in 78 % cases; the decrease of GFR – in 76.1 % cases, in patients with CHF without CKD – in 42 %, 64 % and 68.9 % cases respectively.

The increase of cystatin C levels was more significant than the classical indicators of glomerular function (creatinine and GFR) in patients with CHF and CKD and without CKD in general groups, also in such subgroups as: 1) patients with preserved systolic function (ejection fraction>45%) and systolic dysfunction (ejection fraction≤45%), 2) patients with presence of left ventricular hypertrophy, 3) with normal values of GFR (GFR ≥ 90 ml/min/1.73 m2) and a moderate decline of GFR (GFR ≤ 89 ml/min/1.73 m2). Thus, cystatin C can be considered as an earlier marker of renal function disorders. We found correlations between ejection fraction and left ventricular mass index with cystatin C. Perhaps, cystatin C contributes to formation of hemodynamic disturbances. Early stages of CKD in patients with CHF potentiate disorders of renal function and play the role as an additional risk factor forprogression of heart failure.

Assessment of cystatin C in CHF with CKD and without CKD patients can help doctors in daily practice to improve the quality of early diagnosis and prognosis.

Key words: chronic heart failure, chronic kidney disease I - II stage, cystatin C, glomerular filtration rate (MDRD), creatinine.

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