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Heart Failure and Chronic Kidney Disease: Chloride and markers of fluid overload and diuretic resistance
Session:
Sessão de Posters 18 - Insuficiência cardíaca - Fatores preditores
Speaker:
Bruno Pepe
Congress:
CPC 2024
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.6 Chronic Heart Failure - Clinical
Session Type:
Cartazes
FP Number:
---
Authors:
Bruno Pepe; André Santos Silva; Gonçalo Pimenta; Maria Inês Roxo; Andreia Carnevale; Patrícia Matias; Cátia Sousa; Sofia de Azeredo Pereira; Cândida Fonseca; Carlos Aguiar; Patrícia Branco; Rita Calça
Abstract
<p><span style="color:#000000">Introduction:<br /> Chronic Kidney Disease (CKD) and Heart Failure (HF) share various pathophysiological mechanisms that contribute to the progressive and bidirectional deterioration of the cardiorenal axis. Volume overload (VO) is one of the indicators of dysregulation of this axis, challenging therapeutic management and contributing to the morbimortality of these patients. New and more precise methods of assessing VO have been studied, including the use of new serum markers.</span></p> <p><span style="color:#000000">While traditionally Sodium (Na) has been the focus of guidelines and clinical practice regarding HF, Chloride (Cl) has recently demonstrated a prominent contribution to its pathophysiology and prognosis. Recent studies have identified Cl as a factor of relevance in HF associated congestion, as well as a mechanism of loop diuretic resistance.</span></p> <p><span style="color:#2b2929"><span style="background-color:#f8f8f8">Methods:<br /> Retrospective single-center study, including 76 assessments between June 1, 2021, and March 31, 2023, of patients followed in a Reno-Cardiac consult, an integrated multidisciplinary consult that focuses on patients with cardiorenal syndrome. Demographic data, was analysed, as well as: furosemide dose, Na, Cl, and congestion biomarkers (CA125 and NTproBNP). The Sodium-Chloride Differential (DNACL) was calculated as a method to estimate the chloride deficit. Hypochloremia was defined as serum Cl <96 mEq/L.</span></span></p> <p><span style="color:#2b2929"><span style="background-color:#f8f8f8">Results:<br /> A total of 87% of the patients were male, with a mean age of 80 ± 11 years. The majority of patients had HF with reduced ejection fraction (71%) and were in NYHA class III (57%). The most common comorbidities were Diabetes Mellitus (53%) and Atrial Fibrillation (50%). Regarding chronic kidney disease (CKD), the majority were in stages G3b and G4 (44.7% and 47.4%, respectively).<br /> The mean serum chloride concentration was 101.16 ± 6.04 mEq/L, and 17% had hypochloremia.</span></span></p> <p><span style="color:#2b2929"><span style="background-color:#f8f8f8">In a bivariate analysis, a positive association was found between chloride (Cl) and sodium (Na) values (r=0.752; p<0.001), and higher prescribed furosemide doses were associated with lower Cl values (r=-0.698; p<0.001). Using the calculated Sodium-Chloride Differential (DNACL), a positive association was observed with the prescribed furosemide dose (r=0.514; p<0.001). Of note, is the positive association between CA125 and NTproBNP (r=0.493; p<0.001), both recognized markers of VO, as well as the negative association of Cl with both (respectively r=-0.429, p=0.001 and r=-0.342, p=0.009).</span></span></p> <p><span style="color:#2b2929"><span style="background-color:#f8f8f8">Conclusion:</span></span><br /> <span style="color:#2b2929"><span style="background-color:#f8f8f8">The increasing prevalence of patients with CKD and HF, along with the associated morbimortality, highlights the need to identify new biomarkers to recognize VO and diuretic resistance earlier.<br /> The use of Cl and DNACL appears to be useful as potential markers of diuretic resistance, which may enable the identification of patients requiring alternative therapeutic approaches for managing VO.</span></span></p>
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