Type 2 cardiorenal syndrome: is there a role for diabetes?

Introduction: Diabetes is recognized as a cardiovascu-lar risk factor as well as a nephropathy provocative fac-tor. Upon the ADQI (Acute Dialysis Quality Initiative) Consensus the type 2 cardioreal syndrome is conside-red when a cardiac pathology leads to kidney damage, and type 5 cardiorenal syndrome is considered when a pre-existing pathology, like diabetes, leads to both cardiac and renal impairment. On the other hand, the prevalence of obesity, metabolic syndrome and insulin resistance is quite high in non-diabetic heart failure pa-tients. These comorbidities increase the risk of diabetes constituting a vicious circle.

Objective: To asses the diabetes influience on cardiore-nal syndrome evolution.

Methods: T he prospective study included 83 type 2 cardiorenal syndrome patients who were hospitalized in the Cardiology Clinic between January 2016 and De-cember 2017. The first diagnosis was Heart Failure with reduced or intermediate ejection fraction. For the car-diorenal syndrome diagnosis we estimated GFR using CKD-EPI equation based on Cistatin C and creatinine (reference values RFGcyscr ≤60 ml/min/1.73 m2). We assessed blood glucose, proteinuria, serum creatinine, cystatine C and NT proBNP. The experimental pro-tocol No. 11 (09.12.2015) was approved by the Ethics Committee of the State University of Medicine and Pharmacy „Nicolae Testemitanu”, Chisinau.

Results: 83 patients were evaluated: 42 subjects with diabetes and 41 patients without diabetes. Previous history of episodic hyperglycemia was described by 6 (14.6%) subjects without diabetes. The diabetes du-ration was 5.76 ± 0.97 years. Fasting glycemia had a mean value of 8.68 ± 0.44 mmol/l in the study group and 5.28 ± 0.41 mmol/l in the control group (p>0.05) and postprandial blood glucose had the mean value 9.79 ± 1.64 mmol/l in the study group and 7.59 ± 2.18 mmol/l in the control group (p<0.01). Patients who had cardiorenal syndrome and diabetes simultaneous had lower RFGcyscr-41.76 ml/min/1.73m2 comparati-ve with those without diabetes (45.07 ml/min/1.73m2), for NT-proBNP we recorded the highest values (6595.9 pg/dl) in this group compared with 3938.55pg/dl in the absence of diabetes. In this context, proteinuria was more evident in diabetes 0.15 vs. 0.05 g/l in non-diabetic non cardiorenal patients. Both Creatinine and Cistatin C levels were higher in patients with diabetes compared with those without diabetes 1.49 vs. 1.27 mg/ dl and 1.82 vs. 1.77 mg/dl, respectively. At 6 months follow up the mortality was higher in diabetes sample 11 (26.19%) vs. (21.95%). The occurrence of acute car-diovascular events also was higher in patients with dia-betes 11 (26.19%) vs. 5 (12.2%).

Conclusions: In the present study, diabetes mellitus is not an independent risk factor for cardiorenal syndro-me, this can be explained by the short duration of dia-betes; but it is a good prognstic factor for cardiovascu-lar events occurence.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)