The effect of optimization of diuretic therapy on kidney function during circulartory decompensation

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Resumo

Objective. Evaluation of the effects of sodium-glucose cotransporter type 2 inhibitors (SGLT-2 inhibitors) on the incidence of acute kidney injury (AKI) in patients with decompensated chronic heart failure (CHF) during 5 days of inpatient treatment.

Material and methods. The study included 119 patients with decompensated CHF. Patients were randomized into 2 groups: the control group (loop diuretic therapy) and the main group (combination therapy with SGLT-2 inhibitors and loop diuretics). According to the study protocol, the blood plasma creatinine level with the calculation of the glomerular filtration rate (GFR), daily diuresis and natriuresis were determined.

Results. Against the background of the therapy, from the 2nd day of the study, the level of diuresis in the main group was significantly higher than in the control group (1342.83±159.74 versus 1250.17±134.53; P<0.001). By the 5th day of follow-up, the chance of developing AKI according to the AKIN (OR=5.48, 95% CI 2.22–13.54) and RIFLE (OR=2.45, 95% CI 1.45–5.22) criteria was higher in the control group. At the same time, in the main group, the RIFLE criteria had higher sensitivity, and AKIN – higher specificity. In patients with a low increase in natriuresis (≤90.0 mmol/day), the risk of developing AKI increased by the 5th day of follow-up (OR=5.44, 95% CI 2.40–12.30; P<0.001). The risk of deterioration in GFR was almost 2 times higher in the control group (OR=0.42, 95% CI 0.19–0.93).

Conclusion. Against the background of therapy for CHF decompensation with loop diuretics and SGLT-2 inhibitors, the risk of developing AKI according to AKIN and RIFLE criteria significantly decreased. The AKIN and RIFLE criteria had different sensitivity and specificity, which requires the simultaneous use of both criteria for the diagnosis of AKI. With the use of SGLT-2 inhibitors, the risk of deterioration of SCF decreased, and a high increase in natriuresis was associated with a lower risk of AKI, which proves the nephroprotective properties of SGLT-2 inhibitors in patients during CHF decompensation.

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Sobre autores

Olim Abdullaev

Pirogov Russian National Research Medical University; City Clinical Hospital named after F.I. Inozemtsev of the Moscow Healthcare Department

Autor responsável pela correspondência
Email: abdullayev77177@gmail.com
ORCID ID: 0009-0000-0048-1623

Teaching Assistant at the Department of Propaedeutics of Internal Medicine, Pediatric Faculty, Pirogov Russian National Research Medical University; Cardiologist, City Clinical Hospital named after F.I. Inozemtsev of the Moscow Healthcare Department

Rússia, Moscow; Moscow

Darya Vereshchak

Pirogov Russian National Research Medical University

Email: daria.vereshak@yandex.ru
ORCID ID: 0009-0007-8923-1743

Teaching Assistant at the Department of Propaedeutics of Internal Diseases, Faculty of Pediatrics

Rússia, Moscow

Dmitry Dragunov

Pirogov Russian National Research Medical University; Research Institute of Healthcare Organization and Medical Management of the Moscow Healthcare Department

Email: tamops2211@gmail.com
ORCID ID: 0000-0003-1059-8387

Cand.Sci. (Med.), Associate Professor at the Department of Propaedeutics of Internal Medicine, Pediatric Faculty, Pirogov Russian National Research Medical University

Rússia, Moscow; Moscow

Anna Sokolova

Pirogov Russian National Research Medical University; Research Institute of Healthcare Organization and Medical Management of the Moscow Healthcare Department

Email: sokolova2211@gmail.com
ORCID ID: 0000-0003-0823-9190

Cand.Sci. (Med.), Associate Professor Associate Professor at the Department of Propaedeutics of Internal Medicine, Pediatric Faculty, Pirogov Russian National Research Medical University

Rússia, Moscow; Moscow

Anna Rylova

Pirogov Russian National Research Medical University

Email: rylova@ossn.ru

Dr.Sci. (Med.), Professor, Department of Propaedeutics of Internal Medicine, Pediatric Faculty

Rússia, Moscow

Grigory Arutyunov

Pirogov Russian National Research Medical University

Email: arut@ossn.ru
ORCID ID: 0000-0002-6645-2515

Dr.Sci. (Med.), Professor, Corresponding Member of the Russian Academy of Sciences, Head of the Department of Propaedeutics of Internal Medicine, Pediatric Faculty

Rússia, Moscow

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