Предикторная ценность клинических параметров в отношении эффективности терапии у пациентов с анемией на фоне хронической сердечной недостаточности и хронической болезни почек

Abstract

Проанализирована прогностическая значимость клинико-анамнестических параметров в отношении эффективности терапевтической коррекции анемии на фоне хронической сердечной недостаточности и хронической болезни почек с использованием перорального препарата железа (ІІІ) гидроксида полимальтозного комплекса. Клинико-анамнестические параметры выявили высокую предикторную информативность в отношении эффективности терапевтической коррекции. Наиболее информативными критериями являются длительность и тяжесть хронической сердечной недостаточности, формирование сердечной кахексии, прогрессирование почечной дисфункции, степень тяжести анемии, что обуславливает целесообразность применения данных критериев с целью стратификации эффективности терапевтической тактики.Anemia and renal dysfunction are common comorbid conditions associated with poor prognosis in patients with chronic heart failure (CHF). The etiology of anemia of CHF and chronic kidney disease (CKD) multifactorial and includes iron metabolic disturbances of functional and/or absolute character. Optimization of antianemic therapy of patients with CHF and CKD provides an individual approach to the antianemic medicine appointment by developing predictors of therapeutic correction effectiveness. The predictive value of clinicoanamnestic indicators due to therapeutic correction effectiveness of anemia with CHF and CKD using an oral form of Fe (III) hydroxide complex polymaltose was analyzed. 68 patients with CHF II-IV FC due to ischemic heart disease and CKD II-III stage, who were treated at the cardiology department of the Kharkiv City Clinical Hospital № 27. Among the causes of CKD were: chronic pyelonephritis in 50 patients , diabetic nephropathy in 18 patients. All patients with CHF and CKD had anemia. Hb level was within 78-91 g/l. Diagnosis of anemia was determined according to the criteria of the Medical Committee of Standards of Hematology (ICST, 1989) : reduction of Hb concentration in venous blood less than 120g/l for women and less than 130 g/l for men. CHF FCwas established by NYHA. Availability and stage of CKD was determined according to the classification proposed by experts from the National Kidney Foundation USA (NKF) K / DOQ. Patients with CHF and CKD were treated according to the standards of treatment. Patients with anemic syndrome with CHF and CKD received Fe (III) hydroxide polymaltose complex 100 mg orally 1-2 times a day . Hb target level was within 110-120 g/l. The observation period was 3 months. To assess the prognostic value of clinicoanamnestic parameters, patients (n = 68) who received Fe (III) hydroxide polymaltose complex, at the end of treatment were divided into two groups: a) with good antianemic effect (n = 50) – in order to achieve the target the level of Hb; b) a satisfactory effect (n = 18) - Hb levels approach to the target one (range was 101-105 g/l). Very high informational content (I ≥ 6,0) is given to the duration of CHF (I = 9.55) , CHF FC (I = 8.03) and cardiac cachexia syndrome (I=7.16). High predictive value (6,0> I ≥ 1,0) determined character to the severity of anemia (I = 5.88), presence of edema of the lower extremities and shortness of breath (I = 5.60), acute myocardial infarction (I = 1,94) or post-infarction left ventricular aneurysm (I = 2.82), patient age (I = 2.50) , the severity of CKD (I = 3.28) and the presence of type 2 diabetes mellitus (I = 1.16). Moderate predictor properties (1,0> I ≥ 0,50) identified in relation to body mass index (I = 0.82) , history of stroke (I = 0.76) and the presence of permanent atrial fibrillation (I=0.50). Clinicoanamnestic indicators revealed a high predictive informational content about the effectiveness of therapeutic correction of anemia with CHF and CKD using an oral form of Fe (III) hydroxide polymaltose complex that allows to include them in the predictive algorithms. Most informative criteria is the duration and severity of CHF, cardiac cachexia formation on a background of biventricular cardiac decompensation, progression of renal dysfunction, severity of anemia, which leads to the desirability and feasibility of application of these criteria at all levels of preventive and curative care with the aim of stratification effectiveness of treatment strategies .