Early Detection of Renal Injury and Individualized Treatment Strategies in Chronic Heart Failure

Atakhodjayeva G. A; Korakulova Z. T

doi:10.51699/cajmns.v6i4.2970

Atakhodjayeva G. A Tashkent State Medical University
Korakulova Z. T Tashkent State Medical University

DOI: https://doi.org/10.51699/cajmns.v6i4.2970

Keywords: Chronic Heart Failure, Renal Dysfunction, Biomarkers, Sodium-Glucose Transporter 2 Inhibitors, Individualised Treatment

Abstract

Chronic heart failure (CHF) accompanied by renal dysfunction represents one of the most complex and high-risk conditions in clinical practice. The presence of kidney impairment not only worsens the prognosis but also limits the use of life-saving medications, creating a delicate balance between maintaining cardiac stability and protecting renal function. In this study, 129 patients with CHF were observed, including groups with and without renal dysfunction, alongside a healthy control group. The aim was to evaluate the clinical course, treatment tolerance, and biomarker profiles in order to identify early diagnostic criteria and optimise therapeutic strategies. The findings revealed that patients with renal dysfunction consistently exhibited poorer exercise tolerance, higher NYHA functional class, and markedly elevated levels of NGAL, KIM-1, and cystatin C compared to those with preserved kidney function. Conventional therapies such as ACE inhibitors, ARBs, and MRAs remained effective but required frequent adjustments due to hyperkalemia or worsening renal indices. Diuretic modifications were especially common, underscoring the challenges of balancing congestion relief with renal safety. Importantly, the introduction of SGLT2 inhibitors was associated with improvements in functional capacity and reductions in biomarker burden, demonstrating a protective effect that addressed both cardiac and renal pathways. These results suggest that early recognition of renal injury through biomarker monitoring, combined with careful treatment adjustments, can improve management in CHF patients. The study underscores the need for individualised therapeutic strategies that integrate modern pharmacological options with precise monitoring, ultimately preserving both cardiac performance and kidney function.

References

C. Ronco, M. Haapio, A. A. House, N. Anavekar, and R. Bellomo, "Cardiorenal syndrome," J. Am. Coll. Cardiol., vol. 52, no. 19, pp. 1527–1539, 2008, doi: 10.1016/j.jacc.2008.07.051.

J. J. V. McMurray, M. Packer, A. S. Desai, J. Gong, M. P. Lefkowitz, A. R. Rizkala, et al., "Angiotensin–neprilysin inhibition versus enalapril in heart failure," N. Engl. J. Med., vol. 371, no. 11, pp. 993–1004, 2014, doi: 10.1056/NEJMoa1409077.

M. Packer, S. D. Anker, J. Butler, G. Filippatos, S. J. Pocock, P. Carson, et al., "Cardiovascular and renal outcomes with empagliflozin in heart failure," N. Engl. J. Med., vol. 383, no. 15, pp. 1413–1424, 2020, doi: 10.1056/NEJMoa2022190.

K. Damman, M. A. Valente, A. A. Voors, C. M. O’Connor, D. J. van Veldhuisen, and H. L. Hillege, "Renal impairment, worsening renal function, and outcome in patients with heart failure," Eur. Heart J., vol. 35, no. 7, pp. 455–469, 2014, doi: 10.1093/eurheartj/eht386.

W. Mullens, K. Damman, V. P. Harjola, A. Mebazaa, H. P. Brunner-La Rocca, P. Martens, et al., "Diuretic strategies in patients with acute decompensated heart failure," Eur. Heart J., vol. 40, no. 44, pp. 3621–3634, 2019, doi: 10.1093/eurheartj/ehz761.

G. Savarese and L. H. Lund, "Global public health burden of heart failure," Card Fail Rev., vol. 3, no. 1, pp. 7–11, 2017, doi: 10.15420/cfr.2016:25:2.

P. Ponikowski, A. A. Voors, S. D. Anker, H. Bueno, J. G. F. Cleland, A. J. S. Coats, et al., "2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure," Eur. Heart J., vol. 37, no. 27, pp. 2129–2200, 2016, doi: 10.1093/eurheartj/ehw128.

W. Mullens, K. Damman, J. M. Testani, P. Martens, C. Mueller, J. Lassus, et al., "Evaluation of kidney function throughout the heart failure trajectory—A position statement from the Heart Failure Association," Eur. J. Heart Fail., vol. 22, no. 4, pp. 584–603, 2020, doi: 10.1002/ejhf.1697.

H. J. L. Heerspink, B. A. Perkins, D. H. Fitchett, M. Husain, and D. Z. I. Cherney, "Sodium glucose cotransporter 2 inhibitors in the treatment of diabetes mellitus: Cardiovascular and kidney effects, potential mechanisms, and clinical applications," Circulation, vol. 134, no. 10, pp. 752–772, 2016, doi: 10.1161/CIRCULATIONAHA.116.021887.

M. Haase, P. Devarajan, A. Haase-Fielitz, R. Bellomo, D. N. Cruz, G. Wagener, et al., "The outcome of neutrophil gelatinase-associated lipocalin (NGAL)-positive subclinical acute kidney injury: A multicenter pooled analysis of prospective studies," J. Am. Coll. Cardiol., vol. 57, no. 17, pp. 1752–1761, 2011, doi: 10.1016/j.jacc.2010.11.051.

K. Damman, M. Gori, B. Claggett, P. S. Jhund, M. Senni, M. P. Lefkowitz, et al., "Renal effects and associated outcomes during angiotensin-neprilysin inhibition in heart failure," JACC Heart Fail., vol. 6, no. 6, pp. 489–498, 2018, doi: 10.1016/j.jchf.2018.02.004.

P. A. McCullough, J. A. Kellum, M. Haase, C. Müller, K. Damman, P. T. Murray, et al., "Pathophysiology of the cardiorenal syndrome: implications for diagnosis and treatment," Eur. Heart J., vol. 35, no. 48, pp. 3535–3545, 2014, doi: 10.1093/eurheartj/ehu235.

F. Zannad, J. P. Ferreira, S. J. Pocock, S. D. Anker, J. Butler, G. Filippatos, et al., "SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials," Lancet, vol. 396, no. 10254, pp. 819–829, 2020, doi: 10.1016/S0140-6736(20)31824-9.

A. A. Voors, C. E. Angermann, J. R. Teerlink, S. P. Collins, M. N. Kosiborod, J. Biegus, et al., "The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial," Nat. Med., vol. 28, no. 3, pp. 568–574, 2022, doi: 10.1038/s41591-021-01659-1.

H. Haller, S. Ito, J. L. Izzo Jr, A. Januszewicz, S. Katayama, J. Menne, et al., "Olmesartan for the delay or prevention of microalbuminuria in type 2 diabetes," N. Engl. J. Med., vol. 364, no. 10, pp. 907–917, 2011, doi: 10.1056/NEJMoa1007994.

K. Damman, M. A. Valente, A. A. Voors, C. M. O’Connor, D. J. Van Veldhuisen, and H. L. Hillege, "Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis," Eur. Heart J., vol. 35, no. 7, pp. 455–469, 2014, doi: 10.1093/eurheartj/eht386.

J. J. V. McMurray, S. D. Solomon, S. E. Inzucchi, L. Køber, M. N. Kosiborod, F. A. Martinez, et al., "Dapagliflozin in patients with heart failure and reduced ejection fraction," N. Engl. J. Med., vol. 381, no. 21, pp. 1995–2008, 2019, doi: 10.1056/NEJMoa1911303.

S. G. Coca, A. X. Garg, H. Thiessen-Philbrook, J. L. Koyner, U. D. Patel, H. M. Krumholz, et al., "Urinary biomarkers of AKI and mortality 3 years after cardiac surgery," J. Am. Soc. Nephrol., vol. 25, no. 5, pp. 1063–1071, 2014, doi: 10.1681/ASN.2013070788.