Laboratory predictors of chronic kidney disease progression in patients with heart disease

Aim. To identify markers of chronic kidney disease (CKD) progression in elderly individuals with chronic ischemic heart disease (CHD).

Materials and Methods. The study included 100 patients with a mean age of 70.2 ± 4.1 years with coronary heart disease. 55 (55,0%) women and 45 (45,0%) men participated in the study. All patients had signs of chronic heart failure (CHF) not higher than functional class (FC) II according to the New York Heart Association (NYHA) and no history of kidney disease. Besides, the patients had comorbid conditions, including diabetes mellitus (DM) in 20 (20,0%) patients, arterial hypertension (AH) in 94 (94,0%) patients, and obesity in 24 (24,0%) patients. CKD was diagnosed using the KDIGO criteria. The laboratory tests included general clinical and biochemical parameters in the serum and urine, as well as levels heart failure markers (brain-derived natriuretic peptide (NT-proBNP)). The statistical processing of the findings was carried out using the STATISTICA 12.0 package (StatSoft Inc., license number AXXR012E829129FA), MedCalc and Microsoft Excel.

Results. Multiple regression and the ODDs Ratio method enabled us to establish a set of criteria for renal impairment progression (p < 0,05) in patients with chronic ischemic heart disease (CHD): biochemical analysis data included levels of cystatin C, total cholesterol, low-density lipoprotein cholesterol, lipoprotein (a), and NT-proBNP in the serum, and daily urine protein levels; clinical data included a history of hypertension, myocardial infarction, angina pectoris, and CHF.

Conclusion: The study results support the need to use a combination of markers available in routine clinical practice to successfully prevent CKD progression, rather than relying on traditional indicators.

1. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int, 2013, vol. 3, pp. 1–150. doi: 10.1038/kisup.2012.48.

2. Xie Y., Bowe B., Mokdad A.H. et al. Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016. Kidney Int, 2018, vol. 94(3), pp. 567-581. doi: 10.1016/j.kint.2018.04.011.

3. Eckardt K.U., Delgado C., Heerspink H. J L., et al. Conference Participants. Trends and perspectives for improving quality of chronic kidney disease care: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int, 2023, vol. 104(5), pp. 888-903. doi: 10.1016/j.kint.2023.05.013.

4. Bansal N., Katz R., Dalrymple L., et al. NT-proBNP and troponin T and risk of rapid kidney function decline and incident CKD in elderly adults. Clin J Am Soc Nephrol, 2015, vol. 10(2), pp. 205-14. doi: 10.2215/CJN.04910514.

5. van Mil D., Kieneker L.M., Heerspink H. J L., et al. Screening for chronic kidney disease: change of perspective and novel developments. Curr Opin Nephrol Hypertens, 2024, vol. 33(6), pp. 583-592. doi: 10.1097/MNH.0000000000001016.

6. National kidney foundation. EGFR Calculator. Available at: https://www.kidney.org/professionals/KDOQI/gfr_calculator.

7. Provenzano M., Serra R., Garofalo C., et al. OMICS in Chronic Kidney Disease: Focus on Prognosis and Prediction. Int. J. Mol. Sci, 2022, vol. 23(336). doi: 10.3390/ijms23010336.

8. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classifi cation, and stratifi cation. Am J Kidney Dis, 2002, vol. 39(1), pp. 1–266.

9. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int, 2012, vol. 2, pp. 1–138.

10. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int, 2024, vol. 105(4S), pp. 117-S314. doi: 10.1016/j.kint.2023.10.018.

11. Lousa I., Reis F., Beirão I., et al. New Potential Biomarkers for Chronic Kidney Disease Management–A Review of the Literature. Int J Mol Sci, 2021, vol. 22(43). doi:10.3390/ijms22010043.

12. Bansal N., Katz R., Dalrymple L., et al. NT-proBNP and troponin T and risk of rapid kidney function decline and incident CKD in elderly adults. Clin J Am Soc Nephrol, 2015, vol. 10(2), pp. 205-14. doi: 10.2215/CJN.04910514.