# Impact of Chronic Kidney Disease on Clinical, Laboratory, and Echocardiographic Features in Patients with Chronic Heart Failure

## TL;DR

This study shows that chronic kidney disease worsens heart failure symptoms, increases mortality, and changes clinical features in patients with chronic heart failure.

## Contribution

The study identifies specific clinical and echocardiographic differences in CHF patients with and without CKD.

## Key findings

- CKD patients had higher in-hospital mortality and more severe symptoms like dyspnea and leg swelling.
- CKD was associated with higher CRP and NT-proBNP levels and more advanced NYHA class IV heart failure.
- Non-CKD patients showed more chest pain and palpitations compared to CKD patients.

## Abstract

Objective: The aim of this study was to evaluate the impact of chronic kidney disease (CKD) on clinical presentation, laboratory parameters, ECG, and echocardiographic features of patients with chronic heart failure (CHF). Methods: This retrospective cross-sectional study included 2227 patients hospitalized in a tertiary care center due to CHF. Patients were divided into two groups based on the presence of CKD, defined as eGFR < 60 mL/min/1.73 m2. Demographic, clinical, laboratory, and echocardiographic data were collected for all patients. Comparative analyses were performed to assess differences in cardiovascular risk factors, comorbidities, laboratory parameters, and echocardiographic findings between the two groups. Results: The proportion of men was significantly higher in the non-CKD group, whereas women predominated in the CKD group (p < 0.001). Dyspnea, orthopnea, leg swelling, claudication, and expectoration were significantly more frequent in patients with CKD, while chest pain and palpitations were more common in the non-CKD group (all p < 0.05). A significant difference in the distribution of NYHA functional classes was observed between the groups (p < 0.001), with NYHA class IV being more prevalent in the CKD group and classes II and III more frequent in the non-CKD group. Levels of CRP and NT-proBNP were significantly higher in the CKD group (p < 0.001). In-hospital mortality was 2.5-fold higher in patients with CKD (28.6% vs. 11.1%; p < 0.001). Conclusions: Coexistence of CKD was associated with a more severe clinical presentation, advanced functional limitation, and a distinct laboratory and echocardiographic profile in CHF patients.