• Anna Dudnik National Scientific Center "M.D. Strazhesko Institute of Cardiology"
  • Alina Liashenko National Scientific Center "M. D. Strazhesko Institute of Cardiology"
  • Leonid Voronkov National Scientific Center "M.D. Strazhesko Institute of Cardiology"
Keywords: chronic heart failure, reduced left ventricular ejection fraction, glomerular filtration rate, blood urea nitrogen, microalbuminuria


Chronic heart failure (CHF) is a complex clinical syndrome characterized by progressive course, unsatisfactory quality of life, poor prognosis and high incidence of concomitant renal dysfunction (RD).

The aim of our work was to study the prognostic value of a number of renal function indicators in patients with CHF and a reduced left ventricular ejection fraction (LVEF).

Materials and methods. 134 patients with stable CHF and reduced (<40 %) LVEF, II-IVNYHA class were examined. Patients were divided into two groups according to the level of GFR: the first group of GFR<60 ml/min./1.73 m², the second – GFR≥60 ml/min./1.73 m². The average follow-up period was 13.4 months, the maximum was 27.5 months.

Results. In 53 patients RD was detected (glomerular filtration rate was ˂60 ml/min/1.73 m²), which was 39.5 %. Patients of both groups did not differ in their main hemodynamic parameters, left ventricular ejection fraction, and pharmacotherapy structure, but were older in age and heavier clinically. After the analysis of survival curves of patients depending on GFR, a group of patients with RD had a significantly worse survival prognosis compared to a group without RD. After adjusting the groups by age and NYHA class, the indicated difference was maintained. The subjects were divided according to median levels: blood urea nitrogen, blood urea nitrogen / creatinine ratio, microalbuminuria, albumin / creatinine ratio in urine.

The long-term survival of the formed groups was analyzed. The level of blood urea nitrogen did not significantly influence the prognosis of patients with CHF and reduced LVEF. At the same time, when the groups were divided, depending on the median value of the blood urea nitrogen / creatinine ratio, there was a significantly higher risk of fatal outcome in the group with lower indices. The level of MAU did not significantly affect the survival of patients. In addition, a comparison of the survival of patients with higher and lower values of the albumin / creatinine ratio in the urine revealed a significantly higher risk of death in patients with higher values.


1. The presence of RD (GFR˂60 ml/min/1.73 m²) is observed in 39.5 % of patients with CHF and reduced LVEF and is associated with their worst long-term survival.

2. The BUN and MAU do not have sufficient predictive information about the forecast of long-term survival of the above category of patients.

3. At the same time, the values of the BUN/ Сreatinine ratio ˂24.5 and the ACR ˃12.7 indicate patients with CHF who have a higher long-term risk of death.


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Author Biographies

Anna Dudnik, National Scientific Center "M.D. Strazhesko Institute of Cardiology"

Department of heart failure NSC

Alina Liashenko, National Scientific Center "M. D. Strazhesko Institute of Cardiology"

Department of heart failure

Leonid Voronkov, National Scientific Center "M.D. Strazhesko Institute of Cardiology"

Department of heart failure


Savarese, G., Lund, L. H. (2017). Global Public Health Burden of Heart Failure. Cardiac Failure Review, 3 (1), 7–11. doi:

Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M. et. al. (2014). Heart Disease and Stroke Statistics–2015 Update. Circulation, 131 (4), 29–322. doi:

Crespo-Leiro, M. G., Anker, S. D., Maggioni, A. P., Coats, A. J., Filippatos, G. et. al. (2016). European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT): 1-year follow-up outcomes and differences across regions. European Journal of Heart Failure, 18 (6), 613–625. doi:

Damman, K., Valente, M. A. E., Voors, A. A., O’Connor, C. M., van Veldhuisen, D. J., Hillege, H. L. (2013). Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis. European Heart Journal, 35 (7), 455–469. doi:

Go, A. S., Chertow, G. M., Fan, D., McCulloch, C. E., Hsu, C. (2004). Chronic Kidney Disease and the Risks of Death, Cardiovascular Events, and Hospitalization. New England Journal of Medicine, 351 (13), 1296–1305. doi:

Ronco, C., Haapio, M., House, A. A., Anavekar, N., Bellomo, R. (2008). Cardiorenal Syndrome. Journal of the American College of Cardiology, 52 (19), 1527–1539. doi:

Zamora, E., Lupon, J., Vila, J., Urrutia, A., de Antonio, M., Sanz, H. et. al. (2012). Estimated Glomerular Filtration Rate and Prognosis in Heart Failure. Journal of the American College of Cardiology, 59 (19), 1709–1715. doi:

Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO (2012). Clinical Practice Disease. Kidney inter, 1–150.

Hillege, H. L., Girbes, A. R. J., de Kam, P. J., Boomsma, F., de Zeeuw, D., Charlesworth, A. et. al. (2000). Renal Function, Neurohormonal Activation, and Survival in Patients With Chronic Heart Failure. Circulation, 102 (2), 203–210. doi:

Schrier, R. W. (2008). Blood Urea Nitrogen and Serum Creatinine: Not Married in Heart Failure. Circulation: Heart Failure, 1 (1), 2–5. doi:

Ivanov, D. D. (2005). Khronichna khvoroba nyrok. Mizhnarodnyi endokrynolohichnyi zhurnal, 2, 67–72. Available at:

Dahlöf, B., Devereux, R. B., Kjeldsen, S. E., Julius, S., Beevers, G., de Faire, U. et. al. (2002). Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. The Lancet, 359 (9311), 995–1003. doi:

Zima, T. (2002). Laboratorna diagnostika. Galen, 1146.

Medcalf, E., Newman, D., Gorman, E., Price, C. (1999). Rapid, Robust method for measuring low concentration of albumin in urine. Clin Chem, 3, 446–449. Available at:

Voronkov, L. H. et. al. (Eds.) (2017). Rekomendatsii Asotsiatsii kardiolohiv Ukrainy z diahnostyky ta likuvannia khronichnoi sertsevoi nedostatnosti. Kyiv. Available at:

Damman, K., Testani, J. M. (2015). The kidney in heart failure: an update. European Heart Journal, 36 (23), 1437–1444. doi:

Van Veldhuisen, D. J., Ruilope, L. M., Maisel, A. S., Damman, K. (2015). Biomarkers of renal injury and function: diagnostic, prognostic and therapeutic implications in heart failure. European Heart Journal, 37 (33), 2577–2585. doi:

Parrinello, G., Torres, D., Testani, J. M., Almasio, P. L., Bellanca, M., Pizzo, G. et. al. (2015). Blood urea nitrogen to creatinine ratio is associated with congestion and mortality in heart failure patients with renal dysfunction. Internal and Emergency Medicine, 10 (8), 965–972. doi:

Palazzuoli, A., Ruocco, G., Pellegrini, M., Martini, S., Del Castillo, G., Beltrami, M. et. al. (2014). Patients with Cardiorenal Syndrome Revealed Increased Neurohormonal Activity, Tubular and Myocardial Damage Compared to Heart Failure Patients with Preserved Renal Function. Cardiorenal Medicine, 4 (3-4), 257–268. doi:

Abraham, W. T., Shrier, R. W. (1996). Renal salt and Water Handling in Congestive heart Failure. Congestive Heart Failure. New York: Springer-Verland, 161–173.

Jackson, C. E., Solomon, S. D., Gerstein, H. C., Zetterstrand, S., Olofsson, B., Michelson, E. L. et. al. (2009). Albuminuria in chronic heart failure: prevalence and prognostic importance. The Lancet, 374 (9689), 543–550. doi:

Metra, M., Cotter, G., Gheorghiade, M., Dei Cas, L., Voors, A. A. (2012). The role of the kidney in heart failure. European Heart Journal, 33 (17), 2135–2142. doi:

Sirenko, Yu. M. (2010). Novi mozhlyvosti vyznachennia mikroalbuminurii v klinichnii praktytsi. Arterrialna hipertenziia, 3 (11), 55–57. Available at:

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