Biomarkers to Predict the Renal Response to Cardiac Resynchronization Therapy During a Three-Month Follow-Up: Prospective Clinical Trial

Abstract

BackgroundChronic cardiorenal syndrome type 2 (CRS-T2) has a complex pathophysiology. The objective of this study was to assess renal function using biomarkers associated with nephron injury sites in patients with CRS-T2 following cardiac resynchronization therapy (CRT). MethodsThe research included patients with heart failure in NYHA classes II-IV, in whom CRT devices had been implanted. After 3 months of follow-up, the research group was divided into CRT responders and CRT non-responders. Prior to CRT and after 3 months, renal function was assessed using biomarkers measured in urine and blood samples.ResultsCRT was implanted in 56 patients (aged 66 ± 10 years) with CRS-T2 in the course of coronary artery disease (n = 38; 67.9%) or dilated cardiomyopathy (n = 18). Estimated glomerular filtration rate (eGFRCKD-EPI) was 68.55 ± 20.34 mL/min/1.73m2. After three months follow-up CRT responder group were assessed showing a significant decrease in serum prostaglandin D2 synthase (sPGD2S) and albuminuria (uACR) concentrations. Urine samples of the CRT non-responder group showed significant (p <0.05) increases in lipocalin associated with neutrophil gelatinase (uNGAL) concentrations, and a decrease in cystatin C (uCysC) concentration. There were no significant changes in the concentration of serum creatinine (sCr), CysC and eGFRCKD-EPI between the CRT responders and CRT non - responders groups.ConclusionsThe sCr and eGFRCKD-EPI assessment are useless in evaluation of renal function three months after CRT implantation. Biomarkers that account for the pathophysiology of nephron injury in CRS-T2 and change significantly after CRT are: sPGD2S, uACR, uCysC, and uNGAL. Trial registrationThis study is registered with ClinicalTrials.gov, Identifier: NCT04516525. Registered 15 August 2020 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04516525.