Cardiorenal syndrome type 4: A study of cardiovascular diseases in chronic kidney disease

Abstract

Introduction: The heart and the kidneys are tightly interlinked with each other. So, primary disorder of one of these organs often results in the secondary dysfunction of other. Such interactions play a vital role in the pathogenesis of a clinical entity called cardio-renal syndrome (CRS). CRS type 4 refers to the development of cardiac failure in the patients with CKD. Objectives: To study the prevalence of various cardiac diseases in the patients with CKD and risk factors for it. Methods: Eighty patients with CKD who were being treated at KIMS, Hubli, from 1st January 2015 to 30th June 2015 were selected. Clinical evaluation and relevant investigations including echocardiography were done. Results: Mean age of study population was 43.50 ± 14.53 years. Heart failure with reduced ejection fraction (HFrEF) and Heart Failure with preserved ejection fraction (HFpEF) were present in 21 (26.25%) and 59 (73.75%) respectively. Left ventricular (LV) hypertrophy was present in 55(68.75%). Thus, the prevalence of CRS type 4 was 61 (76.25%). Pericardial effusion was present in 12 (15%). Complete heart block was present in 2 (2.5%). Pulmonary hypertension (PH) was present in 35 (43.75%). Mean central venous pressure (CVP) and interdialysis fluid retention were significantly greater among those with LV failure, compared to those without LV failure (p = 0.0002, p = 0.025 respectively). Mean hemoglobin was significantly lower among patients with LV failure, compared to those without LV failure (p = 0.032). Conclusion: The prevalence of cardiorenal syndrome type 4 is substantially high in patients with CKD and carries adverse outcome in relation to patient management.

Keywords

• Chronic kidney disease
• Cardiorenal syndrome
• Heart failure with reduced ejection fraction
• Heart failure with preserved ejection fraction
• Pulmonary hypertension