Abstract:
Cardiorenal syndrome (CRS) represents a complex interaction between cardiac
and renal dysfunction, significantly worsening clinical outcomes in patients with chronic heart
failure (CHF). Neurohumoral activation, particularly involving the renin–angiotensin
aldosterone system (RAAS), plays a central role in disease progression.
The aim of this study was to evaluate the effects of eplerenone-based therapy on
neurohumoral markers and renal function in patients with CRS associated with CHF (NYHA
class II–III).
A prospective controlled study included 115 patients diagnosed with CRS. Patients were
divided into two groups: standard therapy (n=57) and standard therapy plus eplerenone (n=58).
Serum levels of kallikrein, NT-proBNP, and aldosterone were measured before and after 12
weeks of treatment. Renal function was assessed using cystatin C–based estimation of
glomerular filtration rate (GFR). Statistical analysis was performed using Student’s t-test and
Pearson correlation analysis.
Eplerenone therapy resulted in significant improvement in neurohumoral parameters.
Kallikrein levels increased from 443 ng/ml to 781 ng/ml (p<0.001), while NT-proBNP and
aldosterone levels significantly decreased (p<0.05). Additionally, GFR showed a significant
improvement in the eplerenone group. Clinical symptoms, including dyspnea and exercise
tolerance, also improved.
In conclusion, eplerenone therapy contributes to the modulation of neurohumoral balance
in CRS by suppressing aldosterone activity and indirectly activating the kallikrein–kinin system,
leading to improved renal function. These findings support the use of eplerenone in the early
stages of cardiorenal syndrome
