Anemia e insuficiencia cardíaca con fracción de eyección conservada en pacientes adultos con síndrome cardiorrenal
un estudio de corte transversal
DOI:
https://doi.org/10.31053/1853.0605.v82.n1.44359Palabras clave:
síndrome cardiorrenal, insuficiencia cardíaca diastólica, anemia, enfermedad renal crónicaResumen
Introducción: Los pacientes internados por insuficiencia cardíaca con fracción de eyección conservada (IC-FEc) tienen mayor prevalencia de anemia que aquellos internados por insuficiencia cardíaca con fracción de eyección reducida (IC-FEr). Sin embargo, se desconoce si esta relación se mantiene en pacientes con enfermedad renal crónica, conformando el síndrome cardiorrenal tipo IV.
Métodos: Estudio de corte trasversal, multicéntrico, de pacientes con enfermedad renal crónica internados por insuficiencia cardíaca. El desenlace primario fue la diferencia en la concentración de hemoglobina. El desenlace secundario fue la diferencia en la prevalencia de anemia.
Resultados: Se enrolaron 229 pacientes. La concentración de hemoglobina fue menor en pacientes con IC-FEc en relación a los pacientes con IC-FEr (11,1±1,8 g/dl vs 12,3±2,0 g/dl; p < 0,0001). Presentar IC-FEc estaba asociado a una menor concentración de hemoglobina (β1 = -0,90 g/dl; p = 0,001), luego de incluir el uso de suplementos de hierro, el deterioro moderado a grave del filtrado glomerular, el sexo y la edad. La prevalencia de anemia fue mayor en pacientes con IC-FEc en relación a aquellos con IC-FEr (72,3% vs 59,8%; p = 0,0462). Pertenecer al grupo de IC-FEc no se asoció con anemia (OR = 1,77; p = 0,078), luego de incluir las mismas covariables. Exploratoriamente, pertenecer al grupo de IC-FEc se asoció con anemia moderada a grave, luego de incluir las mismas covariables.
Conclusión: En pacientes con síndrome cardiorrenal tipo IV la concentración de hemoglobina es menor en pacientes internados con IC-FEc, posiblemente jugando un rol en la desestabilización de estos pacientes.
Descargas
Referencias
1. Yan T, Zhu S, Yin X, Xie C, Xue J, Zhu M, Weng F, Zhu S, Xiang B, Zhou X, Liu G, Ming Y, Zhu K, Wang C, Guo C. Burden, Trends, and Inequalities of Heart Failure Globally, 1990 to 2019: A Secondary Analysis Based on the Global Burden of Disease 2019 Study. J Am Heart Assoc. 2023 Mar 21;12(6):e027852. doi: 10.1161/JAHA.122.027852.
2. Bozkurt B, Coats AJS, Tsutsui H, Abdelhamid CM, Adamopoulos S, Albert N, Anker SD, Atherton J, Böhm M, Butler J, Drazner MH, Michael Felker G, Filippatos G, Fiuzat M, Fonarow GC, Gomez-Mesa JE, Heidenreich P, Imamura T, Jankowska EA, Januzzi J, Khazanie P, Kinugawa K, Lam CSP, Matsue Y, Metra M, Ohtani T, Francesco Piepoli M, Ponikowski P, Rosano GMC, Sakata Y, Seferović P, Starling RC, Teerlink JR, Vardeny O, Yamamoto K, Yancy C, Zhang J, Zieroth S. Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure: Endorsed by the Canadian Heart Failure Society, Heart Failure Association of India, Cardiac Society of Australia and New Zealand, and Chinese Heart Failure Association. Eur J Heart Fail. 2021 Mar;23(3):352-380. doi: 10.1002/ejhf.2115.
3. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-3726. doi: 10.1093/eurheartj/ehab368. Erratum in: Eur Heart J. 2021 Dec 21;42(48):4901. doi: 10.1093/eurheartj/ehab670.
4. Fernández A, Thierer J, Fairman E, Giordanino E, Soricetti J, Sociedad Argentina de Cardiología. Consenso de Insuficiencia Cardíaca 2022. Rev Argent Cardiol 2023;91 (Suplemento 2):1-80.
5. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022 May 3;79(17):e263-e421. doi: 10.1016/j.jacc.2021.12.012. Epub 2022 Apr 1. Erratum in: J Am Coll Cardiol. 2023 Apr 18;81(15):1551. doi: 10.1016/j.jacc.2023.03.002.
6. Sanderson JE, Gibson DG, Brown DJ, Goodwin JF. Left ventricular filling in hypertrophic cardiomyopathy. An angiographic study. Br Heart J. 1977 Jun;39(6):661-70. doi: 10.1136/hrt.39.6.661.
7. Hanrath P, Mathey DG, Siegert R, Bleifeld W. Left ventricular relaxation and filling pattern in different forms of left ventricular hypertrophy: an echocardiographic study. Am J Cardiol. 1980 Jan;45(1):15-23. doi: 10.1016/0002-9149(80)90214-3.
8. Hess OM, Grimm J, Krayenbuehl HP. Diastolic simple elastic and viscoelastic properties of the left ventricle in man. Circulation. 1979 Jun;59(6):1178-87. doi: 10.1161/01.cir.59.6.1178.
9. Locatelli F, Del Vecchio L, Minutolo R, De Nicola L. Anemia: A Connection Between Heart Failure and Kidney Failure. Cardiol Clin. 2021 Aug;39(3):319-333. doi: 10.1016/j.ccl.2021.04.003.
10. Ronco C, House AA, Haapio M. Cardiorenal syndrome: refining the definition of a complex symbiosis gone wrong. Intensive Care Med. 2008 May;34(5):957-62. doi: 10.1007/s00134-008-1017-8.
11. Rangaswami J, Bhalla V, Blair JEA, Chang TI, Costa S, Lentine KL, Lerma EV, Mezue K, Molitch M, Mullens W, Ronco C, Tang WHW, McCullough PA; American Heart Association Council on the Kidney in Cardiovascular Disease and Council on Clinical Cardiology. Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies: A Scientific Statement From the American Heart Association. Circulation. 2019 Apr 16;139(16):e840-e878. doi: 10.1161/CIR.0000000000000664.
12. WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organization, 2011. Disponible en: https://iris.who.int/handle/10665/85839
13. Saheb Sharif-Askari N, Sulaiman SA, Saheb Sharif-Askari F, Al Sayed Hussain A, Tabatabai S, Al-Mulla AA. Hospitalized heart failure patients with preserved vs. reduced ejection fraction in Dubai, United Arab Emirates: a prospective study. Eur J Heart Fail. 2014 Apr;16(4):454-60. doi: 10.1002/ejhf.51
14. Ronco C, McCullough P, Anker SD, Anand I, Aspromonte N, Bagshaw SM, Bellomo R, Berl T, Bobek I, Cruz DN, Daliento L, Davenport A, Haapio M, Hillege H, House AA, Katz N, Maisel A, Mankad S, Zanco P, Mebazaa A, Palazzuoli A, Ronco F, Shaw A, Sheinfeld G, Soni S, Vescovo G, Zamperetti N, Ponikowski P; Acute Dialysis Quality Initiative (ADQI) consensus group. Cardio-renal syndromes: report from the consensus conference of the acute dialysis quality initiative. Eur Heart J. 2010 Mar;31(6):703-11. doi: 10.1093/eurheartj/ehp507.
15. International Society of Nephrology. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Inter Suppl. 2013 Jan 3(1): 1–150.
16. Levey AS, Stevens LA. Estimating GFR using the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation: more accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions. Am J Kidney Dis. 2010 Apr;55(4):622-7. doi: 10.1053/j.ajkd.2010.02.337.
17. Margolis JR, Gillum RF, Feinleib M, Brasch RC, Fabsitz RR. Community surveillance for coronary heart disease: the Framingham Cardiovascular Disease Survey. Methods and preliminary results. Am J Epidemiol. 1974 Dec;100(6):425-36. doi: 10.1093/oxfordjournals.aje.a112054
18. McCullough PA, Duc P, Omland T, McCord J, Nowak RM, Hollander JE, Herrmann HC, Steg PG, Westheim A, Knudsen CW, Storrow AB, Abraham WT, Lamba S, Wu AH, Perez A, Clopton P, Krishnaswamy P, Kazanegra R, Maisel AS; Breathing Not Properly Multinational Study Investigators. B-type natriuretic peptide and renal function in the diagnosis of heart failure: an analysis from the Breathing Not Properly Multinational Study. Am J Kidney Dis. 2003 Mar;41(3):571-9. doi: 10.1053/ajkd.2003.50118.
19. Anwaruddin S, Lloyd-Jones DM, Baggish A, Chen A, Krauser D, Tung R, Chae C, Januzzi JL Jr. Renal function, congestive heart failure, and amino-terminal pro-brain natriuretic peptide measurement: results from the ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) Study. J Am Coll Cardiol. 2006 Jan 3;47(1):91-7. doi: 10.1016/j.jacc.2005.08.051.
20. Kasner M, Westermann D, Steendijk P, Gaub R, Wilkenshoff U, Weitmann K, Hoffmann W, Poller W, Schultheiss HP, Pauschinger M, Tschöpe C. Utility of Doppler echocardiography and tissue Doppler imaging in the estimation of diastolic function in heart failure with normal ejection fraction: a comparative Doppler-conductance catheterization study. Circulation. 2007 Aug 7;116(6):637-47. doi: 10.1161/CIRCULATIONAHA.106.661983.
21. Zhou Y, Wang X, Yuan H, Wu L, Zhang B, Chen X, Zhang Y. Impact of recombinant human brain natriuretic peptide on emergency dialysis and prognosis in end-stage renal disease patients with type 4 cardiorenal syndrome. Sci Rep. 2023 Nov 25;13(1):20752. doi: 10.1038/s41598-023-48125-1.
22. Wen Y, Xu Y, Tian H, Jiang S, Jiang G, Li P. Cardiovascular Protective Effects of Oral Hypoxia Inducible Factor Prolyl Hydroxylase Inhibitor Roxadustat in the Treatment of Type 4 Cardiorenal-Anemia Syndrome: Protocol of a Randomized Controlled Trial. Front Med (Lausanne). 2022 Apr 4;9:783387. doi: 10.3389/fmed.2022.783387.
23. Park S, Cho GY, Kim SG, Hwang YI, Kang HR, Jang SH, Kim DG, Song YR, Bae YA, Jung KS. Brain natriuretic peptide levels have diagnostic and prognostic capability for cardio-renal syndrome type 4 in intensive care unit patients. Crit Care. 2009;13(3):R70. doi: 10.1186/cc7878.
24. Suresh H, Moger V, Swamy M. Cardiorenal syndrome type 4: A study of cardiovascular diseases in chronic kidney disease. Indian Heart J. 2017 Jan-Feb;69(1):11-16. doi: 10.1016/j.ihj.2016.07.006.
25. Lai S, Ciccariello M, Dimko M, Galani A, Lucci S, Cianci R, Mariotti A. Cardio-Renal Syndrome Type 4: The Correlation Between Cardiorenal Ultrasound Parameters. Kidney Blood Press Res. 2016;41(5):654-662. doi: 10.1159/000447934.
26. Liu Y, Liu Y, Liu X, Chen J, Zhang K, Huang F, Wang JF, Tang W, Huang H. Apocynin Attenuates Cardiac Injury in Type 4 Cardiorenal Syndrome via Suppressing Cardiac Fibroblast Growth Factor-2 With Oxidative Stress Inhibition. J Am Heart Assoc. 2015 Jun 24;4(7):e001598. doi: 10.1161/JAHA.114.001598.
27. Bhatia RS, Tu JV, Lee DS, Austin PC, Fang J, Haouzi A, Gong Y, Liu PP. Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med. 2006 Jul 20;355(3):260-9. doi: 10.1056/NEJMoa051530.
28. Salah K, Stienen S, Pinto YM, Eurlings LW, Metra M, Bayes-Genis A, Verdiani V, Tijssen JGP, Kok WE. Prognosis and NT-proBNP in heart failure patients with preserved versus reduced ejection fraction. Heart. 2019 Aug;105(15):1182-1189. doi: 10.1136/heartjnl-2018-314173.
29. Ather S, Chan W, Bozkurt B, Aguilar D, Ramasubbu K, Zachariah AA, Wehrens XH, Deswal A. Impact of noncardiac comorbidities on morbidity and mortality in a predominantly male population with heart failure and preserved versus reduced ejection fraction. J Am Coll Cardiol. 2012 Mar 13;59(11):998-1005. doi: 10.1016/j.jacc.2011.11.040.
30. Lemor A, Hernandez GA, Lee S, Patel N, Blumer V, Badiye A, Alfonso C, Fonarow GC, Lindenfeld J, Chaparro S. Impact of end stage renal disease on in-hospital outcomes of patients with systolic and diastolic heart failure (insights from the Nationwide Inpatient Sample 2010 to 2014). Int J Cardiol. 2018 Sep 1;266:174-179. doi: 10.1016/j.ijcard.2018.02.117.
Archivos adicionales
Publicado
Número
Sección
Licencia
Derechos de autor 2025 Universidad Nacional de Córdoba
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.
Se permite la generación de obras derivadas siempre que no se haga con fines comerciales. Tampoco se puede utilizar la obra original con fines comerciales.
Cómo citar
