What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Chronic kidney disease (n=80). Intervention: Chronic kidney disease. Primary outcome: Prevalence of cardiorenal syndrome type 4 (left ventricular failure).

What does this research mean for the field?

Cardiorenal syndrome type 4 is highly prevalent (76.25%) in patients with chronic kidney disease, predominantly presenting as heart failure with preserved ejection fraction, and is associated with lower hemoglobin and higher fluid retention. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

July 16, 2016Open Access

Cardiorenal syndrome type 4: A study of cardiovascular diseases in chronic kidney disease

HSHema SureshKerala School of Mathematics ASArun B. ShivashankarappaSri Jayadeva Institute of Cardiovascular Sciences and Research VMVenkatesh MogerKarnataka Institute of Medical Sciences

Key Result

In 80 patients with chronic kidney disease, the prevalence of cardiorenal syndrome type 4 (left ventricular failure) was 76.25%, with heart failure with preserved ejection fraction present in 73.75%.

Study Design

Type

Cross-Sectional (n=80)

Multicenter

Structured PICO

Population

80 adult patients with chronic kidney disease (mean age 43.5 years, 37.5% female) evaluated for the prevalence of cardiac diseases.

Outcome

Prevalence of various cardiac diseases (including HFrEF, HFpEF, LV hypertrophy, and pulmonary hypertension) in patients with CKD

There is a high prevalence of cardiorenal syndrome type 4, particularly HFpEF and LV hypertrophy, among patients with advanced chronic kidney disease, highlighting the need for routine cardiovascular screening.

Limitations

The patients could not be followed up.
Impact of hemodialysis and correction of risk factors like anemia, systemic hypertension, diabetes mellitus, and volume overload on cardiac function could not be assessed.

Abstract

INTRODUCTION: The heart and the kidneys are tightly interlinked with each other. So, primary disorder of one of these organs often results in the secondary dysfunction of other. Such interactions play a vital role in the pathogenesis of a clinical entity called cardio-renal syndrome (CRS). CRS type 4 refers to the development of cardiac failure in the patients with CKD. OBJECTIVES: To study the prevalence of various cardiac diseases in the patients with CKD and risk factors for it. METHODS: Eighty patients with CKD who were being treated at KIMS, Hubli, from 1st January 2015 to 30th June 2015 were selected. Clinical evaluation and relevant investigations including echocardiography were done. RESULTS: Mean age of study population was 43.50±14.53 years. Heart failure with reduced ejection fraction (HFrEF) and Heart Failure with preserved ejection fraction (HFpEF) were present in 21 (26.25%) and 59 (73.75%) respectively. Left ventricular (LV) hypertrophy was present in 55(68.75%). Thus, the prevalence of CRS type 4 was 61 (76.25%). Pericardial effusion was present in 12 (15%). Complete heart block was present in 2 (2.5%). Pulmonary hypertension (PH) was present in 35 (43.75%). Mean central venous pressure (CVP) and interdialysis fluid retention were significantly greater among those with LV failure, compared to those without LV failure (p=0.0002, p=0.025 respectively). Mean hemoglobin was significantly lower among patients with LV failure, compared to those without LV failure (p=0.032). CONCLUSION: The prevalence of cardiorenal syndrome type 4 is substantially high in patients with CKD and carries adverse outcome in relation to patient management.

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