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Biomarcadores renales y pronóstico en HFpEF y HFrEF: el papel de la albuminuria y el eGFR-A

Claudia Andreea Palcău1,2, Livia Florentina Păduraru1,2, Cătălina Paraschiv1,2

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La albuminuria y la tasa de filtración glomerular estimada (eGFR) predicen los resultados en la insuficiencia cardíaca (IC). La reducción de eGFR es un predictor más fuerte en HF con fracción de eyección reducida (HFrEF), mientras que la albuminuria es predictiva en todos los fenotipos de HF.

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Área de la Ciencia:

  • Cardiología
  • Nefrología
  • Los biomarcadores

Sus antecedentes:

  • La insuficiencia cardíaca (IC) y la enfermedad renal crónica (ERC) con frecuencia coexisten, lo que afecta los resultados de los pacientes.
  • La albuminuria y la tasa de filtración glomerular estimada (eGFR) son marcadores clave de la ERC con valor pronóstico en la IR.
  • Las funciones predictivas de la albuminuria y el eGFR en la HF con fracción de eyección preservada (HFpEF) frente a la HF con fracción de eyección reducida (HFrEF) requieren una aclaración adicional.

Objetivo del estudio:

  • Revisar y evaluar sistemáticamente el pronóstico significativo de la albuminuria y el eGFR en pacientes con HF.
  • Comparar las funciones predictivas de estos biomarcadores entre los fenotipos HFpEF y HFrEF.
  • Informar la toma de decisiones clínicas y la estratificación del riesgo en el manejo de la HF.

Principales métodos:

  • Búsqueda sistemática de la literatura en las principales bases de datos para los estudios clínicos pertinentes.
  • La inclusión de estudios que informen sobre eventos cardiovasculares, mortalidad o hospitalizaciones por HF.
  • Se realizaron análisis de subgrupos basados en la fracción de eyección (HFpEF frente a HFrEF).

Principales resultados:

  • Se incluyeron veintiún estudios que mostraron asociaciones consistentes entre albuminuria, reducción del eGFR y aumento del riesgo de mortalidad y hospitalización.
  • La reducción de eGFR demostró asociaciones pronósticas más fuertes en las poblaciones de HFrEF.
  • Se encontró que la albuminuria era predictiva en ambos fenotipos HFpEF y HFrEF.

Conclusiones:

  • La albuminuria y el eGFR son biomarcadores pronósticos valiosos en la HF, ayudando a la estratificación del riesgo.
  • Existen implicaciones pronósticas diferenciales entre HFpEF y HFrEF, lo que sugiere enfoques específicos del fenotipo.
  • Se necesita más investigación para validar los hallazgos y guiar las estrategias terapéuticas personalizadas.