Jishanth, M (2011) A Study of Characteristics and Outcome of Cardio Renal Syndrome in Heart Failure. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Heart failure is one of the leading causes of hospitalizations throughout the world. Prevalence is 1% between the ages of 50 and 59 years, progressively increasing to >10% over age of 80 years. Concomitant and significant renal dysfunction is common in patients with heart failure. Increasingly, the syndrome of heart failure is one of the cardiorenal failure, in which concomitant cardiac and renal dysfunctions exist, with each accelerating the progression of the other. One fourth of patients hospitalized for the treatment of acute decompensated heart failure will experience significant worsening of renal function, which is associated with worse outcomes. It remains unclear whether worsening renal function specifically contributes to poor outcomes or whether it is merely a marker of advanced cardiac and renal dysfunction. Diuretic resistance, with or without worsening renal function, is also common in acute decompensated heart failure, although the definition of diuretic resistance, its prevalence, and prognostic implications are less well defined. The term cardiorenal syndrome has been variably associated with cardiorenal failure, worsening renal function, and diuretic resistance but is more comprehensively defined as a state of advanced cardiorenal dysregulation manifest by one or all of these specific features. The pathophysiology of the cardiorenal syndrome is poorly understood and likely involves interrelated hemodynamic and neurohormonal mechanisms. When conventional therapy for acute decompensated heart failure fails, mechanical fluid removal via ultrafiltration, hemofiltration, or hemodialysis may be needed for refractory volume overload. While ultrafiltration can address diuretic resistance, whether ultrafiltration prevents worsening renal function or improves outcomes in patients with cardiorenal syndrome remains unclear. Newer therapeutic agents, including nesiritide, vasopressin antagonists and adenosine antagonists, hold promise for the future, and clinical trials of these novel agents are underway. AIM OF THE STUDY: To do a cross sectional study on the prevalence, predictors and short term outcome in patients with heart failure and cardiorenal dysfunction(cardiorenal syndrome) with regard to variations in Demographic characteristics, Etiologic factors, Severity of cardiac dysfunction, Associated risk factors, Treatment factors and Outcome difference during hospital stay and 2 month follow up. MATERIALS AND METHODS: Patient Selection: The study group comprised of 50 heart failure patients. The patient subgroup was drawn from a consecutive series of 78 heart failure patients admitted in the Department of Medicine, Stanley Medical College and Government Stanley hospital, during the period of 4 months from March 1st 2010 to June 30th 2010. For the study purpose clinical diagnosis of heart failure was confirmed with echocardiographic evaluation. Inclusion Criteria: All patients admitted with cardiac failure of any etiology with a duration of hospital stay more than 24 hrs with or without cardiorenal dysfunction. Exclusion Criteria: 1. Patients with documented chronic kidney disease including renal artery stenosis. 2. Patients with Diabetic nephropathy (proteinuria >300mg/24 hrs). 3. Patients with history of NSAID abuse. 4. Serum creatinine >5 mg/dL. 5. Patients not satisfying above criteria( hospital stay <24 hrs). RESULTS: 50 patients who were admitted in medical wards with heart failure who satisfied the inclusion and exclusion criteria were enrolled in this study. Out of the 50 patients, 32 were males and 18 were females. The youngest among them was 16 yrs and oldest being 72 years of age. 18 patients out of 50 satisfied criteria for diagnosis of heart failure with Cardiorenal Syndrome (Serum creatinine >1.3 mg% at admission and creatinine clearance <60 ml/kg/1.73m² OR a rise in serum creatinine >25% on attempted diuresis). Further analysis were carried out among this subgroup labeling them as CRS group and the remaining 32 patients as Heart Failure Alone group. Both groups were comparable as far as the etiology of heart failure was concerned. Half of the patients were ischemic heart disease and another one-fourth were having rheumatic heart disease in both groups. Out of 50 patients majority belonged to NYHA Class III and Class IV (24 in each group, 96%), only 4 % patients were admitted with NYHA Class II symptoms. The BMI of both groups were identical ( Mean BMI of heart failure alone group 22.97 kg/m² and that of cardiorenal syndrome group 23.33 kg/m² and the difference was statistically not significant (p value 0.6896). CONCLUSION: The cardiorenal syndrome often heralds the transition of heart failure to an end-stage, preterminal (stage D) heart failure. The conclusions of the study are the following. 1. The prevalence of Cardiorenal syndrome in heart failure is quite high (36%). 2. History of 2 or more previous hospitalizations and advancing age in patients with heart failure predispose them in developing cardiorenal syndrome. Patients who developed cardiorenal syndrome were older by a mean of 10 years (p value = 0.0140). 3. The relative risk of cardiorenal dysfunction is high with Smoking, Diabetes Mellitus and Left ventricular Diastolic Dysfunction. 4. In addition to prolonged hospitalization (by 3.28 days) and slower recovery, the development of cardiorenal syndrome is an independent predictor of frequent readmissions. The in-hospital and 2 month follow up mortality is 3 times higher in cardiorenal syndrome when compared to heart failure alone group. Under-treatment of the cardiorenal syndrome may have lethal consequences at an individual level and huge potential adverse consequences at a public health level. The depth of knowledge and complexity of care necessary to offer best therapy to these patients demands a multidisciplinary approach, combining the expertise of cardiology, nephrology, and critical care.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Characteristics ; Outcome ; Cardio Renal Syndrome ; Heart Failure. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 23 Mar 2018 17:57 |
| Last Modified: | 24 Mar 2018 16:12 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6532 |
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