Effects of ambulatory self-control on renal function and electrolyte metabolism in patients with severe heart failure

Abstract

Aim. To investigate the effects of the ambulatory self-control treatment strategy on renal function, electrolyte metabolism, functional status, and the number of repeat hospitalisations in patients with chronic heart failure (CHF). Material and methods. In total, 122 patients with severe CHF (NYHA class III-IV) were divided into 3 groups: Group I – ambulatory self-control after in-hospital education in the “CHF Patient School”; Group II – standard in-hospital education in the “CHF Patient School”; and Group III – controls. Group I participants could selfadminister torasemide (in pre-determined doses; under control of blood potassium, sodium, and creatinine) in case of oedema and dyspnoea development. If torasemide treatment was ineffective, Group I patients would have a telephone consultation with a doctor. During the in-hospital treatment, as well as after 3, 6, and 9 months of ambulatory treatment, the following parameters were assessed: the number of repeat hospitalisations, functional status (6-minute walking test), calculated glomerular filtration rate (GFR; CKD-EPI), morning microalbuminuria, serum levels of potassium and sodium, therapy compliance, and knowledge on CHF-related issues. Results. The number of repeat hospitalisations in Group I, compared to Groups II and III, decreased by 37% and 45%, respectively. In the 6-minute walking test at 9 months, the distance in Group I increased from 174,5 m to 248,5 m, while in Groups II and III, it did not change significantly. Group I did not demonstrate any negative GFR dynamics, while this parameter progressively and similarly decreased in the other two groups. At 9 months, albuminuria levels in Group I (44,5±25,3 mg/l) were significantly lower than in Group II (58,7±32,5 mg/l) and Group III (62,8±36,9 mg/l). Among Group I patients, hyperkalaemia was not observed, and hyponatraemia was significantly less common than in Groups II and III. The CHF knowledge and therapy compliance were better in Group II, compared to Group III, only during the first 3 months of the follow-up; Group I demonstrated consistently high levels of these parameters throughout the study period. Conclusion. The strategy of ambulatory self-control, compared to the standard ambulatory observation, significantly reduced the need for repeat hospitalisations, improved functional status, electrolyte metabolism, and therapy compliance parameters, and postponed the progression of renal dysfunction in CHF patients.