Trajectories of long-term outcome of heart failure with concomitant chronic kidney disease: the significance of high-sensitivity C-reactive protein

Inflammation is intimately associated with atherosclerotic disease, including in patients with chronic heart failure (CHF), and high-sensitivity C-reactive protein (hsCRP) levels play a key role in determining severity and outcome. Objective: to study the potential of serum hsCRP for predicting the outcome of ischemic heart failure in the presence of chronic kidney disease (CKD). Material and methods. Clinical signs and 5-year outcomes of patients with CHF (n = 517), including those in combination with CKD (n = 207), were studied. Results and conclusions. The phenotype of CHF in combination with CKD was characterized by female gender, older age, a higher prevalence of arterial hypertension, diabetes mellitus, previous myocardial infarction and coronary intervention, lower cardiorespiratory endurance, higher levels of hsCRP (p = 0.005), low-density lipoprotein cholesterol (p = 0.021), non-high-density lipoprotein cholesterol (p = 0.015). Patients with CHF with hsCRP > 3 mg/L have a higher 5-year risk of death from any cause, cardiovascular death, and achieving the composite endpoint (CCT). An increase in hsCRP for every 1 mg/l in CHF increases the risk of death from all causes (HR = 1.1; 95% CI 0.99–1.21), cardiovascular death (HR = 1.11; 95% CI 1.01–1.23). Death from any cause and cardiovascular death with CHF, incl. in the presence of CKD, hsCRP > 3.07 mg/l was predicted. Achieving CCT was predicted in patients with CHF with hsCRP > 2.69 mg/l, in patients with a combination of CHF and CKD — with hsCRP > 2.5 mg/l.