Introduction: Cardio-renal syndrome is a pathophysiological disorder of the heart and kidneys in which chronic or acute dysfunction of one can lead to chronic or acute dysfunction of the other. The objective of this study was to determine the prevalence of cardio-renal syndrome in the Medical Department of the Tombouctou Hospital in Mali. Methods: It is about a descriptive transversal study carried out over 18 months, from January 01st, 2020 to June 30th, 2021 and relating to the analysis of 75 files of patients hospitalized for heart failure and with impaired renal function. Results: The frequency of cardio-renal syndrome was 6.4% with a predominance of men (sex ratio: 2). Hypertension was the most widely described risk factor (50.6%). The history was dominated by chronic heart failure (14.6%) and diabetes (6.6%). The average age was 58 with extremes of 18 and 90. The main aetiologies were dilated cardiomyopathy (46.6%) and ischemic heart disease (20%). Symptoms were dominated by dyspnea (90.6%) and edema of the lower limbs and face (74.6%) accompanied by cough (74.6%). Anemia was noted in 15 patients (20%). The mean clearance (MDRD) was at 32 ml/min. Doppler echocardiography found left ventricular dilation (66.6%), lower left ventricular systolic fraction (64%) and kinetic abnormalities (20%). The kidney ultrasound performed in 9 patients returned to normal in 8 cases and in 1 patient the kidneys were small. Eight deaths (10.6%) were noted . Conclusion: Cardio-renal syndrome is a common feature in which mixed failure is observed in the unfavorable course of heart disease and nephropathy. Its prevalence is unfortunately under evaluated in cardi ological settings in Africa and particularly in Mali, hence the interest of a more advanced study.
Cardio-renal syndrome is a pathophysiological disorder of the heart and kidneys in which chronic or acute dysfunction of one can lead to chronic or acute dysfunction of the other [
His diagnosis is made on the basis of a picture of clinical heart failure with impaired renal function.
According to the US ADHERE registry, at least 65% of patients with a picture of acute heart failure have a creatinine clearance < 60 ml/min [
In Africa, the prevalence of the cardio-renal syndrome is little assessed in cardiology settings; in Senegal, a study conducted in a cardiology department in Dakar found 3.7% [
In Mali, no study has dealt with this aspect of the cardio-renal syndrome, hence the interest of our study.
The objective of this work was to determine the hospital prevalence of cardio-renal syndrome in the Medical Department of the Tombouctou Hospital in Mali.
This was a descriptive transversal study carried out in the medical department of the Tombouctou hospital from January 2020 to June 2021, during which we included 75 patients with heart failure associated with impaired renal function.
| TYPES | CHARACTERISTICS |
|---|---|
| Type 1 | Acute CRS characterized by acute decompensated heart failure leading to acute renal failure. |
| Type 2 | Chronic CRS is characterized by chronic heart failure which leads to chronic kidney disease. |
| Type 3 | Acute reno-cardiac syndrome is due to acute renal failure which leads to acute cardiac dysfunction, such as arrhythmia or heart failure. |
| Type 4 | Chronic reno-cardiac syndrome is characterized by primary chronic kidney disease that contributes to cardiac dysfunction. |
| Type 5 | Also called secondary CRS where there is simultaneous renal and cardiac involvement due to systemic disorders such as sepsis or systemic lupus erythematosus. |
CRS: Cardio-renal syndrome.
The volunteers were patients hospitalized with heart failure and impaired kidney function. After obtaining informed consent, they were included in the study.
Data collection was done from hospital records.
The data collected were socio-demographic, clinical (functional signs, physical signs), cardiovascular and para-clinical risk factors (trans-thoracic echocardiography, renal ultrasound, biological: blood count, glycemia, creatinemia, ionogramblood).
Clinical: patients with symptoms suggestive of heart failure.
The positive diagnosis of cardio-renal syndrome was based on:
- a clinical syndrome of heart failure,
- a serum creatinine greater than 1.4 mg/dl in women and 1.3 mg/dl in men.
Claudio Ronco’s classification was used in this work.
Cardio-renal syndrome is a pathophysiological disorder of the heart and kidneys in which chronic or acute dysfunction of one can lead to chronic or acute dysfunction of the other.
Signs of heart failure (HF) were dyspnea (according to NYHA), crackling rales, left galloping noise for left HF and hepatalgia, right galloping noise, hepatomegaly, chest edema, lower limbs, the turgor of the jugular veins for the right CI. Renal impairment was considered for serum creatinine greater than 1.4 mg/dl in women and 1.3 mg/dl in men.
Data were collected using the observational medical record and recorded in a questionnaire. This questionnaire was written by the scientific manager and the principal investigator and included.
The statistical population studied was patients with heart failure and impaired renal function.
The variables studied were:
- Quantitative includes the age of the patients, the seniority of hypertension and diabetes, the number of days of hospitalization and of deaths.
- Qualitative included the sex of the patients, symptoms, description of doppler echocardiographic abnormalities and biology. The questionnaire was submitted to a follow-up test on the recruitment procedure and data analysis.
The questionnaire was submitted to a daily quality control before being collected.
Excel 2016 software was used for data collection and then analyzed by SPSS 24 software.
Informed consent was obtained with strict respect for confidentiality.
Out of 1165 hospitalized patients, 75 had cardio-renal syndrome, including 25 women. The hospital prevalence was 6.4%. The average age was 58 with extremes of 18 and 90. Chronic heart failure was the most common medical history (14.6%) (
Chronic heart failure dominated the personal medical history (14.6%) of frequency and global heart failure dominated the circumstances of discovery (74.6%).
The etiologies of cardio-renal syndrome were dilated cardiomyopathy (46.6%), ischemic heart disease (20%), chronic renal failure (8%), hypertrophic cardiomyopathy (2.6%) and diabetes (2.6%) (
According to Ronco’s classification, cardio-renal syndrome type 1 dominated (72%) followed by type 2 (14.6%) (
| Personal medical history | Effectives | Percentage (%) |
|---|---|---|
| Chronic heart failure | 11 | 14.6 |
| Diabetes | 5 | 6.6 |
| Chronic renal failure | 2 | 2.6 |
| HIV | 1 | 1.3 |
| Circumstances of discovery | ||
| Global heart failure | 56 | 74.6 |
| Left ventricular failure | 12 | 16 |
| Others | 7 | 9 |
| Etiology | Effectives | Percentage (%) |
|---|---|---|
| Dilated cardiomyopathy | 35 | 46.6 |
| Ischemic heart disease | 15 | 20 |
| Chronic renal failure | 6 | 8 |
| Hypertrophic cardiomyopathy | 2 | 2.6 |
| Diabetes | 2 | 2.6 |
| Others | 10 | 13.3 |
| Total | 75 | 100 |
| Classification | Effectives | Percentage (%) |
|---|---|---|
| Type 1 | 54 | 72 |
| Type 2 | 11 | 14.7 |
| Type 3 | 4 | 5.3 |
| Type 4 | 3 | 4 |
| Type 5 | 3 | 4 |
| Total | 75 | 100 |
Dilated cardiomyopathy and ischemic heart disease dominated the etiologies with 46.6% and 20% frequency, respectively.
It was dominated by type 1,i.e. (72%).
All the patients benefited from treatment with a diuretic and a sodium-reduced diet. ACE inhibitors were prescribed in 69.3% (52 patients), beta blockers in 18 patients (24%) and calcium channel blockers in 16% (12 patients).
The duration of hospitalization was 5.4 days. The outcome was favorable in the majority of cases (72%). Complications included 20% refractory heart failure, 8% dialysis and 2.6% cerebral embolism (2 cases). We recorded 8 deaths,i.e. 10.6% lethality. These were refractory heart failure (20%) and stroke (6.6%)
The prevalence of cardio-renal syndrome in our series is of the order of 6.4% higher than the 3.7% of the Dakar study [
| Complication | Effectives | Percentage (%) |
|---|---|---|
| Refractory heart failure | 15 | 20 |
| ACFA | 14 | 18.6 |
| Death | 8 | 10.6 |
| Chronic Renal Insufficiency with dialysis | 6 | 8 |
| Intracavitary thrombus | 5 | 6.6 |
The average age was 58 years, higher than the 57.26 ± 16.04 years of kingue [
The male sex predominated (sex ratio at 2) in phage with Kingue (sex ratio at 1.3) and Bodian (sex ratio at 1.7) unlike Go which had a female predominance at 55% [
The etiological factors of CRS are dominated by hypertensive dilated cardiomyopathy (46.6%) and ischemic heart disease (20%) in agreement with Bodian [
In the majority of cases (72%), the SCR was type 1 versus (97.22%) for type 2 in Bodian [
In our series, the picture of global heart failure (74.6%) was the most common discovery method, consistent with the rest of the literature [
This difference can be explained by the fact that our study took place in a medical service against the Dakar series in the cardiology service. We recorded a low case fatality rate of 10.6% compared to most of the literature due to the small sample size [
The limitations of our study:
The small size of our sample; financial difficulties and the security situation linked to the rebellion in the area prevented patients from being consulted at the hospital.
Cardio-renal syndrome is a common feature in which mixed failure is observed in the unfavorable course of heart disease and nephropathy. Its prevalence is unfortunately underestimated in cardiological settings in Africa and in particular in Mali, hence the interest of a more advanced study.
We focus on raising public awareness and health workers on the regular and correct monitoring of high blood pressure.
At the level of political decision-makers: Reinforce accessibility to care.
Research: We believe that prospective and multicentre studies are necessary to better determine the prevalence of CRS in Africa and in Mali in particular.
We thank the management of the Tombouctou Hospital for completing the administrative and regulatory formalities for this work, as well as the patients for their trust.
The authors declare no conflicts of interest regarding the publication of this paper.
Traore, B., Sidibé, S., Mariko, S., Kantako, K., Konaté, M., Diallo, K., Diallo, N., Sako, M., Sacko, A.K., Kassambara, Y., Menta, I. and Coulibaly, S. (2022) Cardio-Renal Syndrome: Epidemiolo- gical Aspect in the Medicine Department of Tombouctou Hospital. World Journal of Cardiovascular Diseases, 12, 123-132. https://doi.org/10.4236/wjcd.2022.122013
Last name:………………….First name:………………………….Sex:……….
Profession:………………… Residence:…………….......…….Age:…………
1) pattern:
2) Date: 3) Duration:
a) hypertension d) Diabetes
b) chronic kidney failure f) Heart valve disease
c) Heart failure g) others:
1) Hypertension 4) Age > 60 ans
2) Smoking 5) Obesity
3) Dyslipidemia 6) Famaly history of myocardial infarction
1) General examination
a) Signsof congestions b) others:
2) Cardiac Examination:
1) EKG:
a) Heart rate: c) Hypertrophies
b) Conduction desorders d) Evidence of ischemia
2) Ultrasonic cardiography
a) kinematic: c) Sidewalls:
b) EF: d) Péricardite
3) Biology
a) Blood count formula: b) Urea:
b) Glycemia: d) Creatininemia:
4) Kidney ultrasound:
a) Standard: b) others:
1) CRS Type
a) I c) III e) V
b) II d) IV
2) Cardiomyopathies:
3) Kidney failure:
4) others:
1) Favorable 2) Death 3) Refer