MODULATORY EFFECTS OF EPLERENONE ON NEUROHUMORAL BALANCE AND RENAL FUNCTION IN CARDIORENAL SYNDROME: A PROSPECTIVE STUDY

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