Reduced Albuminuria and Potassemia Indicate Early Renal Repair Processes after Resynchronization Therapy in Cardiorenal Syndrome Type 2

Abstract

Background: Patients with chronic cardiorenal syndrome type 2 (T2-CRS) who qualify for resynchronization therapy (CRT) are exposed perioperatively to potentially nephrotoxic factors including contrast agents and blood loss.

Methods: The objective of this prospective interventional study was to assess the effects of CRT on renal function in patients with T2-CRS within the first 48 hours following implantation. Initially, 76 patients (15% female; aged 69 ± 9.56 years) with heart failure (New York Heart Association classes II-IV), ejection fraction ≤ 35%, and QRS > 130 ms were included in the study. During CRT implantation, a nonionic contrast agent (72.2 ± 44.9 mL) was administered. Prior to and 48 hours following implantation, renal function was evaluated using the following serum biomarkers: creatinine (sCr), estimated glomerular filtration rate (using the Chronic Kidney Disease Epidemiology Collaboration equation [eGFRCKD-EPI]), and the electrolyte and urine biomarkers albumin (uAlb), albumin/creatinine ratio (UACR), and neutrophil gelatinase-associated lipocalin (uNGAL).

Results: Before CRT, patients classified as NYHA class III or IV had higher uNGAL levels in comparison to uNGAL levels after CRT (43.63 ± 60.02 versus 16.63 ± 18.19; p=0.041). After CRT implantation, uAlb, UACR, and potassium levels were reduced (p < 0.05), and uNGAL, sCr, and eGFRCKD-EPI were unchanged. The contrast medium volume did not correlate with the test biomarkers (p > 0.05).

Conclusions: In patients with T2-CRS, uNGAL is a biomarker of kidney injury that correlates with the NYHA classes. A stable uNGAL value before and after CRT implantation confirms the lack of risk of contrast-induced nephropathy. Reduced albuminuria and blood potassium are biomarkers of improving T2-CRS in the early post-CRT period.

Conflict of interest statement

The authors declare that there are no conflicts of interest regarding the publication of this paper.

Copyright © 2020 Agnieszka Gala-Błądzińska et al.

Figures

Figure 1

Algorithm for qualifying patients with chronic cardiorenal syndrome type 2, including indications for CRT implantation.

Figure 2

Graph showing the correlation of uNGAL with NYHA heart failure classes in the study group prior to CRT implantation; abbreviations: NYHA, New York Heart Association class; uNGAL, lipocalin associated with neutrophil gelatinase in a single sample of urine.

Figure 3

Impact of CRT implantation on selected renal parameters across the entire group of patients 48 hours following implantation. (a) uAlb, urinary albumin concentration in a single morning sample of urine prior to CRT implantation; uAlb 48, albumin concentration in a single morning sample of urine 48 hours following CRT implantation. (b) uACR, urinary albumin to creatinine ratio prior to CRT implantation; uACR 48, urinary albumin to creatinine ratio 48 hours following CRT implantation. (c) uNGAL, lipocalin associated with neutrophil gelatinase in a single morning sample of urine prior to CRT implantation; uNGAL 48, lipocalin associated with neutrophil gelatinase in a single morning sample of urine 48 hours following CRT implantation. (d) uNCR, urinary NGAL to creatinine ratio prior to CRT implantation; uNCR 48, urinary NGAL to creatinine ratio 48 hours following CRT implantation. (e) eGFR, estimated glomerular filtration rate calculated using Chronic Kidney Disease Epidemiology Collaboration prior to CRT implantation; eGFR 48, estimated glomerular filtration rate calculated using Chronic Kidney Disease Epidemiology Collaboration 48 hours following CRT implantation. (f) K, serum potassium concentration prior to CRT implantation; K 48, serum potassium concentration 48 hours following CRT implantation.