Asymmetric dimethylarginine (ADMA) as an important risk factor for the increased cardiovascular diseases and heart failure in chronic kidney disease

The development of chronic kidney disease (CKD) is a risk factor not only for cardiovascular diseases, but also for heart failure (HF). This article is a literary review on the use of Sodium-glucose co-transporter-2 (NGLT2) inhibitors in patients with CKD and HF. The paper describes in detail the action of NGLT2 inhibitors in the light of nephro- and cardioprotection. In addition to the glucosuric effect of NGLT2 inhibitors, they have a natriuretic and diuretic effect. One of the effects of NGLT2 inhibitors is the ability to lower blood pressure. One of the key effects of NGLT2 inhibitors, explaining nephroprotection, is the influence on glomerular filtration. The ability of NGLT2 inhibitors to suppress the peroxidation in mitochondria of proximal tubular epithelium was shown. Another putative mechanism of the organ protection action of NGLT2 inhibitors is their ability to inhibit the activation of the sympathetic nervous system.The results of studies using empagliflozin in HF and CKD are presented. In particular, the EMPA-REG OUTCOME study showed that in patients with type 2 diabetes and concomitant cardiovascular diseases, empagliflozin led to a 35% decrease in hospitalization risk due to decompensated HF and decrease of cardiovascular death risk by 38% regardless of baseline renal function. According to the EMPEROR-Reduced study, empagliflozin showed a favorable safety profile.

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Abstract 4351: Albuminuria is a Risk Factor for Adverse Events in Heart Failure Independent of the Presence of Chronic Kidney Disease

Circulation ◽

10.1161/circ.118.suppl_18.s_870-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Adheesh Agnihotri ◽

Kalkidan Bishu ◽

James Arnold ◽

Gary Gustafson ◽

Inder S Anand

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Chronic Kidney Disease ◽

Risk Factor ◽

Kidney Disease ◽

Adverse Events ◽

Systolic Blood Pressure ◽

Left Ventricular ◽

Creatinine Ratio ◽

Albumin Creatinine Ratio

Background : Chronic kidney disease (CKD) is a known risk factor for adverse events in patients with heart failure (HF). Whether albuminuria defined as urine albumin creatinine ratio ≥30 mg/g with or without CKD is also a risk factor for adverse events, is unclear. Methods : Data was abstracted from the electronic medical records of 442 patients admitted to the Minneapolis VA Medical Center with a primary diagnosis of HF, and an outpatient measurement of albumin creatinine ratio between September 2002 and March 2006. Multivariable Cox regression analysis was used to determine the impact of albuminuria on mortality and hospitalizations for HF at 1-year. Results : Albuminuria was seen in 54% (238/442) patients at baseline. Patients with albuminuria were more likely to have edema, higher systolic blood pressure, left ventricular hypertrophy, lower eGFR and use of beta-blockers (all p<0.05). Albuminuria correlated (p<0.05) with serum creatinine (rho=0.23), systolic blood pressure (0.37), and LVEF (0.13). The presence of albuminuria did not increase the risk of death (HR 0.65, 95% CI 0.38 –1.11), but was strongly associated with the risk of hospitalization for HF at 1-year (HR 1.77, 95% CI 1.11–2.82, p=0.017) independent of age, gender, h/o HTN, DM, CAD, PVD, COPD, CKD, atrial fibrillation, EF, use of ACE-I, spironolactone and beta-blocker. Conclusion : The presence of albuminuria is an independent prognostic marker for hospitalizations for heart failure.

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