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Nonalcoholic fatty liver disease and chronic kidney disease in patients with chronic heart failure

Author: 
Drapkina, O., Zyatenkova, E. and Ivashkin, V.
Subject Area: 
Health Sciences
Abstract: 

Currently, the routine clinical practice does not include the measurement of glomerular filtration rate (GFR) in patients with the absence of risk factors for Chronic Kidney Disease (CKD). However, recent studies have shown that in patients with nonalcoholic fatty liver disease (NAFLD) it is necessary to estimate GFR, even in the absence of classic risk factors for CKD. Early detection of kidney damage in patients with CHF and NAFLD will help to titrate the correct dose of drugs, avoiding chemical overdose. Materials and Methods: The study included 77 patients with CHF. In all patients, the diagnosis of heart failure was confirmed by measuring the quality NT-pro BNP. The severity of the clinical manifestations of heart failure and the functional status of patients were assessed. All patients underwent clinical and biochemical blood tests, ECG, ultrasound of the liver. Size of the heart chambers, wall thickness of the myocardium and epicardial fat were evaluated by the echocardiography. In all patients GFR, CKD-EPI were calculated, staging of CKD was performed, Fatty Liver Index and NAFLD fibrosis score evaluated. Results: More than half (68%) of the patients with CHF had C 2 stage of CKD, 6% of patients had a C1 stage; 13% - C 3a, 9% - C 3b, 4% - C4 stage CKD. The average value of GFR was 65,4 ± 14,4 ml / min / 1.73 m2. Statistical analysis revealed that with the increase of HF functional class stage of CKD also increase (p = 0,0027). The severity of CKD increases with the level of plasma glucose (p = 0.0022). In addition, it was found that the stage of CKD correlate with increase in the size of the right atrium (p = 0.044). In assessing the biological age of the vessel wall with the help of apparatus "Angioscan" it was revealed that the larger stage of CKD, the higher biological age of the vessel wall in patients with chronic heart failure (p = 0.0027). It was also found that the more severe damage to the kidneys in patients with CHF, the higher level of fibrosis marker PIIINP infarction (p = 0.047). According to FLI, 40% of patients are likely to have hepatic steatosis, in 34% of patients the data for the presence of hepatic steatosis is not obtained, 26% of patients took an intermediate value. According to the NFS, 26% of patients had a high likelihood of liver fibrosis, 9% of patients did not have, 65% of patients are in the "gray zone". The analysis of the correlations revealed that with increasing values of NFS reduced GFR increases CKD stage (p = 0.049). Conclusions: Patients with heart failure and concomitant diseases of the liver and kidneys are in need of more intensive treatment with compulsory inclusion of drugs which reduce the process of fibrosis and remodeling of the vascular wall and have protective properties in relation to the liver and kidneys.

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