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Manuscript Mohamed Tantawiey
Manuscript Mohamed Tantawiey
We are pleased to present our manuscript entitled “Incidence and types of Cardiorenal
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Incidence and types of Cardiorenal Syndrome in
Telephone number:01111224624
E-mail: mtantawiey@gmail.com
Abstract
Background; CRS and it's classification to 5 types according to the different diseases Which
effect on kidneys and heart with acute or chronic types and using broad spectrum from
laboratories and radiological investigations , early detection of the type is a fundamental goal
for the prevention of congestive heart failure in high-risk patients and deterioration of kidney
functions tested , Aim and objectives; was to identify the different types & clinical
Aswan university hospital. The calculated sample size was obtained using simple random
sample of the patients. Results: Heart failure and renal failure related to each other in
chronicity result in different types of CR. Conclusion; ECG and kidney function test are a
quick bedside test and a non-invasive reliable technique for the assessment of Generalized
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Keywords: chest pain, AKI: dyspnea, dialysis, generalized edema
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Introduction
It is estimated that up to 50% of patients with chronic heart failure (HF) develop renal
mortality. However, the prevalence and clinical impact of renal dysfunction in hypertrophic
CRS is defined as any acute or chronic problem in the heart or kidneys that could result in an
acute or chronic problem of the other. (2) CRS divided into 2 major groups, cardiorenal and
renocardiac syndromes, based on the primum movements of the disease process. This was
further grouped into 5 subtypes based on disease acuity and sequential organ: Type 1: a sharp
decline in cardiac function that results in an acute decrease in renal function, type 2: chronic
cardiac dysfunction that results in a sustained reduction in renal function, type 3: a sharp
decline in renal function that results in an acute reduction in cardiac function, type 4: a
chronic decline in kidney function that results in chronic cardiac dysfunction and type 5:
systemic diseases that result in both cardiac and renal dysfunction. (3,4)
The overall prognosis is poor. There are multiple mortality and readmission predictor
calculators available to predict the individual patient’s prognosis further. They use multiple
variables to predict in-hospital mortality and readmission rate, including ECG, the blood urea
nitrogen (BUN), systolic blood pressure (BP), serum creatinine, Pelvi abdominal us and
echocardiography.
The aim of this study is to identify the different types & clinical evaluation of cardiorenal
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This is a cross-sectional study was conducted in Internal Medicine& cardiology departments
at Aswan university hospital. We included 100 participants with the following inclusion
obstructive pulmonary disease (COPD) and hemodynamic parameters (systolic & diastolic BP
and blood urea, 2) serum sodium, 3) potassium, 4) serum calcium, 5) phosphorus, 6) uric acid,
Patients were classified according to the five types of CRS. Moreover, heart failure was
classified into mild, moderate, or severe. (5) While acute kidney injury was classified into 3
stages of severity based on serum creatinine (sCr) and urine output criteria into Stage 1,2 or 3,
as proposed by the Acute Kidney Injury Network (AKIN) criteria (6). Chronic kidney disease
(CKD) was diagnosed according to K-DOQI guidelines (7). Renal functions were evaluated
Statistical Analysis:
Data were summarized in mean ± SD for quantitative data and frequencies for qualitative
data. A two-sided P-value of < 0.05 was considered statistically significant. We used SPSS 25
Ethical consideration:
The study Protocol was submitted for approval from ethics committee and institutional review
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Results
We included 100 participants, with average age 58.73 ± 14.81. It was found that 54.0% aged
50-70 years, while 23.0% of them aged more than or equal 70 years. Half of the studied
patients were male (50.0%). The most common chronic diseases were hypertension (74.0%),
and diabetes mellitus (63.0%), while only 15.0% of them suffering from COPD (Table 1).
There was no significant relation between type of CRS and age and gender (P= 0.265 &
0.062). white, type of CRS was statistically significant in relation to CKD (P= 0.011*), HD
(P= 0.004*), and COPD (P= 0.034*). While there were no statistically significant relations
It was found that there was a statistically significant relation of type of CRS with Pelvi-
abdominal radiology (P= 0.000*), however, there was no statistically significant relation with
Discussion
Cardiorenal syndrome (CRS) lacked a universally accepted definition for long, and numerous
related key questions yet remain unanswered. Clinical guidelines have classically treated
cardiac and renal failure separately, but the characteristics of CRS should be elucidated more
This study shows that more than one-half of the studied patients (54.0%) aged 50-70 years,
while 23.0% of them aged more than or equal 70 years. The mean age of the patients was
58.73 ± 14.81. Regarding to gender, half of the studied patients were male (50.0%).
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In his study Abdullah et al., (10) showed that the incidence of CRS among 61-70 years was
18%, 31-40 was 13%, 71- 80 years was 8% and more than 80 years was 4% Calculated mean
age is 55.3±12.8 years. While Reddy et al., (11) included 106 of them, 69 (43.7%) were 60–
80 years old, 65 (41.1%) were 40–60 years old, 16 (10.1%) were ≥80 years old, and eight
This study shows that according to general conditions of the studied patients. The most
common chronic diseases were HTN (74.0%), and diabetes mellitus (63.0%) and CKD were
In agreement with our results Abdullah et al., (10) showed that the most common risk factor
was HTN (75%) followed by diabetes (44%), smoking (35%), dyslipidaemia (30%) and
Alcohol (14%). Also Hu et al., (12) showed that 71.30% has HTN, 42.70% with diabetes,
24.7% patients were with a history of chronic kidney disease and 9.80% with COPD. H. R.
Shah et al., (13) showed that among the study population, 39 (78%) patients were
hypertensive and 32 (64%) were diabetic. Whereas 25 (50%) had underlying chronic kidney
According to type of CRS, it was found that only 10% of them were type I, 33.0% of them
were type II, 25.0% were type III, 19.0% were type IV, and only 13.0% of them were type V.
H. R. Shah et al., (13) showed that out of 50 patients enrolled in study, 23 (46%) subjects
presented with type I CRS, 11 (22%) subjects with type II CRS, 13 (26%) subjects with type
IV CRS and 3 (6%) subjects with type 5 CRS, no individual came under the category of type
3 CRS. While Gigante et al., (14) results showed that 61 patients had clinical signs
compatible with a diagnosis of CRS type I (32.1%); 30 patients had CRS type II (15.8%); 15
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patients had CRS type III (7.9%); 11 patients had CRS type IV (5.8%), and 73 patients had
CRS type V (38.4%). CRS was more common in males (68.9% of patients).
It was found that there were statistically significant relations of type of CRS with CKD (P=
0.011*), with HD (P= 0.004*), and with COPD (P= 0.034*). While there were no statistically
significant relations with DM (P= 0.643), and with IHD (P= 0.625), while there was no
statistically significant relation with other chronic disease. Also, there were no statistically
significant relations of ejection fraction with Pelvi-abdominal (P= 0.782), and with ECHO
In agreement to our results Gigante et al., (14)showed that diabetes mellitus (p = 0.45), HTN
(p = 0.27), ischemic heart disease (p = 0.1) and COPD (p = 0.21) are not significant risk
factors for the onset of CRS. Also, H. R. Shah et al., (13) showed that the association of co-
morbidities (HTN, DM, COPD and CAD) with outcome were found to be statistically
insignificant.
On the other hand Reddy et al., (11)showed that there is a significant association between
CRS and risk factors, such as DM (P = 0.030), COPD (P = 0.016), and CKD (P > 0.001) with
CRS.
There was a statistically significant relation of type of CRS with Pelvi-abdominal (P=
0.000*), while there was no statistically significant relation with ECHO findings (P= 0.198).
associated with the development of the CRS. Also, Reddy et al., (11) showed that according
to Echocardiography at 180 days, 38 patients was HFpEF (EF >50%), 39 patients was
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Limitations
The present study has some limitations, sample size is one of them, as our sample was
comparatively less. Future studies with larger sample size and more comprehensive and
longer follow-up are required to validate the findings. In addition, the study was conducted in
a tertiary care hospital in a city. Thus, the findings cannot be extrapolated to the general
population, including rural citizens. Nevertheless, the present study provides a basis for future
Conclusion:
Current study suggests that types of CRS is related to chronic diseases, CRS is associated
with CKD, HD, and COPD. Moreover, to diagnosis CRS, and treat it early are very important
Funding Sources: This research received no grant from any funding agency in the public,
References
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Table 1: Personal data of the studied patients
No. (%)
Age: (years) Mean ± SD 58.73 ± 14.81
< 50 23 (23%)
50 - 70 54 (54%)
> 70 23 (23%)
Gender: Male 50 (50%)
Female 50 (50%)
General condition DM 63 (63%)
HTN 74 (74%)
CKD 40 (40%)
IHD 30 (30%)
HD 19 (19%)
COPD 15 (15%)
Type of CRS Type I 10
Type II 33
Type III 25
Type IV 19
Type V 13
Table 2: Relation between type of CRS and personal data
Type of CRS
Personal data Type I & II Type III & IV Type V P-value
No. % No. % No. %
Age: (years)
< 50 7 16.3 10 22.7 6 46.2
0.265
50 - 70 26 60.5 23 52.3 5 38.5
> 70 10 23.3 11 25.0 2 15.4
Gender:
Male 27 62.8 19 43.2 4 30.8 0.062
Female 16 37.2 25 56.8 9 69.2
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Table 3: Relation between type of CRS and general condition
Type of CRS
General
Type I & II Type III & IV Type V P-value
condition
No. % No. % No. %
DM 29 67.4 27 61.4 7 53.8 0.643
HTN 30 69.8 34 77.3 10 76.9 0.704
CKD 10 23.3 24 54.5 6 46.2 0.011*
IHD 15 34.9 12 27.3 3 23.1 0.625
HD 14 32.6 2 4.5 3 23.1 0.004*
COPD 4 9.3 6 13.6 5 38.5 0.034*
Table 4: Relation between type of CRS and radiology
Type of CRS
Radiology Type I & II Type III&IV Type V P-value
No. % No. % No. %
Pelvi-abdominal:
Normal 24 55.8 5 11.4 0 0.0 0.000*
Bilateral G I nephropathy 16 37.2 17 38.6 7 53.8 0.546
Bilateral G II nephropathy 2 4.7 10 22.7 5 38.5 0.007*
Bilateral G III nephropathy 1 2.3 12 27.3 1 7.7 0.003*
ECHO:
Normal 10 23.3 14 31.8 1 7.7
DDG 10 23.3 13 29.5 6 46.2
MR 21 48.8 23 52.3 12 92.3 0.198
TR 20 46.5 20 45.5 10 76.9
Picture of IHD 10 23.3 3 6.8 0 0.0
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