PREVENTION OF THE PROGRESSION OF CHRONIC KIDNEY DISEASE BY DECOMPENSATION OF CHRONIC HEART FAILURE

Abstract

The progression of chronic kidney disease in patients with acute
decompensation of chronic heart failure is associated with a complex of
causes. In acute decompensation of chronic heart failure with a
decrease in the left ventricular ejection fraction, there is a decrease in
renal perfusion, which leads to a subsequent decrease in the
glomerular filtration rate (GFR) [1]. Another possible cause may be
adverse reactions of the body to aggressive therapy with loop diuretics,
which is part of the complex therapy for acute decompensation of
chronic heart failure [2]. Such adverse reactions include: activation of
neurohormonal systems, leading to increased resistance of the renal
vessels, as well as hypovolemia and electrolyte disturbances, leading to
ischemia and hyperosmolar damage to the renal tubules [3, 4]. The
progression of chronic kidney disease is an independent risk factor for
the development of cardiovascular complications and the cause of
death in patients is 10-20 times more common than in the general
population [5]. Prevention of the progression of chronic kidney disease
in patients with acute decompensation of chronic heart failure can be
effective in improving kidney perfusion by reducing the resistance of
the organ's vessels and reducing the adverse reactions of loop diuretic
therapy. Improvement of renal perfusion is possible with the addition
of standard therapy for acute decompensation of chronic heart failure
with dihydropyridine-type calcium antagonists. These drugs can
achieve a pronounced renoprotective effect in patients with diseases of
the cardiovascular system and diabetic nephropathy by restoring the
vasomotor tone of the afferent arterioles of the renal glomeruli [6, 7].
Reducing the adverse reactions of loop diuretic therapy is possible
when changing the drug administration regimen from single bolus
injections to extended intravenous infusion