Features of the course of chronic kidney disease and left ventricle geometry in women and men at the pre-dialysis stage of the disease
- Autores: Murkamilov I.T.1,2, Aitbaev K.A.3, Fomin V.V.4, Yusupova T.F.5, Duysheeva G.K.1, Yusupov F.A.5
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Afiliações:
- Kyrgyz State Medical Academy named after. I.K. Akhunbaev
- Kyrgyz-Russian Slavic University named after B.N. Yeltsin
- National Center of Cardiology and Therapy named after. Acad. Mirsaid Mirrakhimov
- Sechenov University
- Osh State University
- Edição: Volume 16, Nº 2 (2024)
- Páginas: 24-34
- Seção: Original Articles
- URL: https://journals.eco-vector.com/2075-3594/article/view/634547
- DOI: https://doi.org/10.18565/nephrology.2024.2.24-34
- ID: 634547
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Resumo
An analysis of the course of chronic kidney disease (CKD) and structural modification of the left ventricle (LV) at the pre-dialysis stage of the disease is presented.
Objective. Analysis of the features of the course of CKD and LV geometry at the predialysis stage, taking into account gender differences.
Material and methods. An open prospective study included 120 CKD patients at the predialysis stage. The mean age of the examined patients was 37.4±13.2 years, and the mean follow-up period was 14 months. Patients with CKD not receiving hemodialysis were selected for follow-up. All individuals signed informed consent for therapy and follow-up. Taking into account gender differences, all examined patients were divided into 2 age-matched groups: 52 women and 68 men. Along with a general clinical examination, all patients underwent echocardiography (EchoCG) at baseline and during follow-up. Glomerular filtration rate (GFR) was calculated using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) formula. During the study period, all patients were contacted through communication and semi-quarterly medical examinations, to which patients were invited to the clinic.
Results. At baseline, women and men did not differ significantly in age, anthropometric parameters, hemodynamics, lipid profile, electrolyte content, blood fibrinogen, daily proteinuria and GFR. The Hb level and the number of peripheral blood erythrocytes were significantly lower in women. At the same time, in the group of men, the total serum protein level was significantly lower, and creatinine – higher than in the group of women. The proportion of patients on glucocorticoid therapy was significantly higher among men (50.0 and 34.6%; p<0.05). In addition, echoCG indicators - linear dimensions of the left atrium (LA, cm), end-systolic (ESD) and diastolic dimensions (EDD) of the left ventricle (LV) - were significantly higher in men compared to women. There were no differences in the incidence of left ventricle hypertrophy (LVH) between the study groups. Initially, eccentric type LVH was the predominant type of remodeling in women (82.4%), and concentric type – in men (53.8%). During the follow-up, compared with baseline data the following indicators significantly decreased in women; erythrocyte sedimentation rate (ESR) – 15.0 (8.0;27.0) and 20.0 (10.0;33.5) mm/hour (p<0.05), fibrinogen concentration – 6.104 (4.107;6.771) and 6.216 (4.884;8.880) g/l (p<0.05), calcium level – 1.08±0.21 and 1.33±0.51 mmol/l (p <0.05) and daily proteinuria values – 2.299 (1.619;3.936) and 3.645 (1.968;6.623) g (p<0.05). At the same time, the albumin – 31.9±10.7 g/l and 27.1±10.3 g/l (p<0.05) and serum creatinine levels increased. In the group of men, there was a tendency towards a decrease in Hb level and the value of daily proteinuria, and also a significant decrease in ESR rates – 8.0 (4.0;21.0) and 16.0 (7.5;32.5) mm/hour (p<0.05) and blood triglyceride (TG) levels – 1.81 (1.18;2.36) versus 2.48 (1.75;3.43) mmol/l (p<0.05). In addition, there was a significant increase in the blood serum albumin and total protein levels. The proportion of patients with elevated C-reactive protein (CRP) levels also decreased: 8 (11.7%) and 15 (22.0%) (p <0.05) and there was an increase in creatinine concentration: 115.5 (86.5; 259.0) and 114.0 (83.5;174.0) µmol/l (p<0.05), decrease in estimated GFR – 66.2 (38.6;103.8) versus 84.9 ( 55.2;110.0) ml/min (p<0.05) and serum calcium levels – 1.16±0.36 and 1.49±0.52 mmol/l (p<0.05). A comparative analysis of the studied parameters between women and men in the dynamics of the study revealed the following. In the group of men, ESR indicators – 8.0 (4.0;21.0) and 15.0 (8.0;27.0) mm/hour (p<0.05), and blood TG concentrations – 1.81 (1.18;2.36) and 2.20 (1.64;3.24) mmol/l (p<0.05), were significantly lower, and the mean sodium and median serum creatinine levels were higher compared to those in women. In women, the number of peripheral blood red blood cells was also significantly lower. During the follow-up, the LV size turned out to be significantly higher in men compared to women: 3.40±0.49 cm and 3.22±0.35 cm (p<0.05), and concentric LV remodeling developed in 11.5% of women, which was not observed in the group of men. In women, by the end of the study, the interventricular septum (IVS) thickness significantly increased: 0.94±0.21 cm and 0.90±0.20 cm (p<0.05) compared to the initial value. Similar shifts in the IVS thickness were typical for men: 0.96±0.16 and 0.92±0.13 cm (p<0.05). In the group of women, a close direct relationship between the LV myocardial mass index (LVMI) and the systolic blood pressure – BP (r=0.676; p=0.005), diastolic blood pressure (r=0.651; p=0.005) and daily proteinuria (r=0.317; p=0.043), and an inverse relationship with estimated GFR (r=-0.410; p=0.008) were revealed Similar correlation shifts were also observed between LVMI and clinical and laboratory parameters in men, with the exception of daily proteinuria (r=0.082; p=0.506).
Conclusion. During the follow-up period, the indicators of ESR, fibrinogen concentration, blood calcium and the value of daily proteinuria significantly decreased in women, which was accompanied by an increase in the blood serum albumin and creatinine levels. In men, by the end of the follow-up period, there was a significant decrease in ESR and TG levels with a simultaneous increase in the blood serum albumin and total protein levels. The proportion of patients with elevated CRP levels decreased, and there was also a tendency towards a decrease in blood Hb concentration and the value of daily proteinuria. In addition, over the course of the study, the serum creatinine levels in men increased, which was accompanied by a decrease in the estimated GFR. Comparative analysis of data between groups revealed that ESR and blood TG levels in men turned out to be significantly lower, and the mean sodium and median serum creatinine levels were significantly higher compared to women. According to the echocardiography data during follow-up, LV ESR was significantly higher in men compared to women. During the follow-up period, both women and men had a significant increase in IVS thickness compared with the initial indicators. 11.5% of women developed concentric LV remodeling. In both groups, there was a statistically significant direct relationship between the LVMI and systolic and diastolic blood pressure, and an inverse relationship with the estimated GFR.
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Sobre autores
Ilkhom Murkamilov
Kyrgyz State Medical Academy named after. I.K. Akhunbaev; Kyrgyz-Russian Slavic University named after B.N. Yeltsin
Autor responsável pela correspondência
Email: murkamilov.i@mail.ru
Dr.Sci. (Med.), Associate Professor at the Department of Faculty Therapy, KSMA named after. I.K. Akhunbaev, Professor at the Department of Therapy No. 2, the KRSU named after. B.N. Yeltsin
Киргизия, Bishkek; BishkekKubanych Aitbaev
National Center of Cardiology and Therapy named after. Acad. Mirsaid Mirrakhimov
Email: aitbaev.kuban1940@gmail.com
Dr.Sci. (Med.), Professor at the Department of Pathological Physiology
Киргизия, BishkekViktor Fomin
Sechenov University
Email: fomin_vic@mail.ru
Dr.Sci. (Med.), Professor, Corresponding Member of RAS, Head of the Department of Faculty Therapy No. 1, Institute of Clinical Medicine named after. N.V. Sklifosovsky, Vice-Rector for Innovation and Clinical Activities, Sechenov University
Rússia, MoscowTursunoy Yusupova
Osh State University
Email: yusupova_tursunoy_f@mail.ru
6th- year Student at the Faculty of Medicine
Киргизия, OshGulzat Duysheeva
Kyrgyz State Medical Academy named after. I.K. Akhunbaev
Email: guzyu_88@mail.ru
Teaching Assistant at the Department of Faculty Therapy
Киргизия, BishkekFurkat Yusupov
Osh State University
Email: furcat_y@mail.ru
Dr.Sci. (Med.), Professor, Head of the Department of Neurology, Neurosurgery and Psychiatry, Faculty of Medicine
Киргизия, OshBibliografia
- Бобкова И.Н., Камышова С.Е. Современный взгляд на лечение мембранозной нефропатии. Тер. архив. 2020;92(6):99–104. doi: 10.26442/00403660.2020.06.000676. [Bobkova I.N., Kamyshova E.S. Modern view on treatment of membranous nephropathy. Ter. Arkh. 2020;92(6):99–104 (In Russ.)].
- Wang L., Xu X., Zhang M., et al. Prevalence of Chronic Kidney Disease in China: Results From the Sixth China Chronic Disease and Risk Factor Surveillance. JAMA. Int. Med. 2023;183(4):298–310. doi: 10.1001/jamainternmed.2022.6817.
- Burnier M., Damianaki A. Hypertension as Cardiovascular Risk Factor in Chronic Kidney Disease. Circ. Res. 2023;132(8):1050–63. doi: 10.1161/CIRCRESAHA.122.321762.
- Zeng X., Zeng Q., Zhou L., et al. Prevalence of Chronic Kidney Disease Among US Adults With Hypertension, 1999 to 2018. Hypertension. 2023;80(10):2149–58. doi: 10.1161/HYPERTENSIONAHA.123.21482.
- Клинические рекомендации. Хроническая болезнь почек (ХБП). Нефрология. 2021;5:10–84. doi: 10.36485/1561-6274-2021-25-5-10-84. [Clinical recommendations. Chronic kidney disease (CKD). Nephrol. 2021;5:10–84 (In Russ.)].
- Teichholz L.E., Kreulen T., Herman M.V., Gorlin R. Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence or absence of asynergy. Am. J. Cardiol. 1976;37(1):7–11. doi: 10.1016/0002-9149(76)90491-4.
- Devereux R.B., Reichek N. Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation. 1977;55(4).613–18. [PMID: 138494].
- Williams B., Mancia G., Spiering W., et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J. Hypertens. 2018;36(10):1953–2041. doi: 10.1097/HJH.0000000000001940.
- Шило В.Ю., Земченков А.Ю., Гуревич К.Я. и др. Российские национальные рекомендации по диагностике и лечению анемии при хронической болезни почек. Нефрология и диализ. 2016;18(1):19–34. [Shilo V.Yu., Zemchenkov A.Yu., Gurevich K.Ya., et al. Russian national clinical recommendations for diagnosis and treatment of anemia in chronic kidney disease. Nephrol. Dial. 2016;18(1):19–34 (In Russ.)].
- Pergola P.E., Davidson M., Jensen C., et al. Effect of Ziltivekimab on Determinants of Hemoglobin in Patients with CKD Stage 3-5: An Analysis of a Randomized Trial (RESCUE). J. Am. Soc. Nephrol. 2024;35(1):74–84. doi: 10.1681/ASN.0000000000000245.
- Shaikh H., Hashmi M.F., Aeddula N.R. Anemia of Chronic Renal Disease. 2023 Feb 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. [PMID: 30969693].
- Милованов Ю.С., Козловская Л.В., Милованова Л.Ю. и др. Факторы риска развития анемии на ранних стадиях хронической болезни почек. Тер. архив. 2017;89(6):41–7. doi: 10.17116/terarkh201789641-47. [Milovanov Yu.S., Kozlovskaya L.V., Milovanova L.Yu., et al. Risk factors for anemia in the early stages of chronic kidney disease. Ter. Arkh. 2017;89(6):41–7. (In Russ.)].
- Резник Е.В., Никитин И.Г. Кардиоренальный синдром у больных с сердечной недостаточностью как этап кардиоренального континуума (Часть I): определение, классификация, патогенез, диагностика, эпидемиология (обзор литературы). Архивъ внутренней медицины. 2019;9(1):5–22. doi: 10.20514/2226-6704-2019-9-1-5-22. [Reznik E.V., Nikitin I.G. Cardiorenal syndrome in patients with chronic heart failure as a stage of the cardiorenal continuum (Part I): definition, classification, pathogenesis, diagnosis, epidemiology. Rus. Arch. Int. Med. 2019;9(1):5–22 (In Russ.)].
- Meza K., Biswas S., Talmor C., et al. Response to oral iron therapy in children with anemia of chronic kidney disease. Pediatr. Nephrol. 2024;39(1):233–42. doi: 10.1007/s00467-023-06048-z.
- Thomas E., Klomhaus A.M., Laster M.L., et al. Associations between anemia and FGF23 in the CKiD study. Pediatr. Nephrol. 2024;39(3):837–47. doi: 10.1007/s00467-023-06160-0.
- Добронравов В.А., Смирнов А.В., Безруких А.М. и др. Анемия и преддиализные стадии хронической болезни почек: клиническое значение, распространенность и факторы риска. Нефрология. 2006;10(3):7–13. doi: 10.24884/1561-6274-2006-10-3-7-13. [Dobronravov V.A., Smirnov A.V., Bezrukikh A.M., et al. Аnemia and pre-dialysis stages of chronic kidney disease: clinical significance, incidence and risk factors. Nephrol. (2006;10(3):7–13 (In Russ.)].
- Farag Y.M.K., Blasco-Colmenares E., Zhao D., et al. Effect of Anemia on Physical Function and Physical Activity in CKD: The National Health and Nutrition Examination Survey, 1999–2016. Kidney360. 2023;4(9):e1212–22. doi: 10.34067/KID.0000000000000218.
- Keane W.F., Brenner B.M., De Zeeuw D., et al. The risk of developing end-stage renal disease in patients with type 2 diabetes and nephropathy: the RENAAL study. Kidney Int. 2003;63(4):1499–507. doi: 10.1046/J.1523-1755.2003.00885.X.
- Айтбаев К.А., Муркамилов И.Т., Фомин В.В. Нефрогенная анемия: новые физиологические подходы к терапии на основе имитации гипоксических ответов. Альманах клинической медицины. 2017;45(7):565–74. doi: 10.18786/2072- 0505-2017-45-7-565-574. [Aitbaev K.A., Murkamilov I.T., Fomin V.V. Anemia of chronic kidney disease: novel physiological approaches to therapy based on simulation of hypoxic response. Alm. Clini. Med. 2017;45(7):565–74 (In Russ.)].
- Locatelli F., Ravera M., Esposito C., et al. A novel scenario in the therapeutic management of anemia of chronic kidney disease: placement and use of roxadustat. J. Nephrol. 2024 Jan 8. doi: 10.1007/s40620-023-01849-9.
- Yeruva K., Akella R. Hypertension Clinical Trials. 2023 Apr 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2024 Jan. [PMID: 37276302].
- Scurt F.G., Ganz M.J., Herzog C., et al. Association of metabolic syndrome and chronic kidney disease. Obes. Rev. 2024;25(1):e13649. doi: 10.1111/obr.13649.
- Locatelli F., Marcelli D., Comelli M., et al. the Northern Italian Cooperative Study Group, Italy, Proteinuria and blood pressure as causal components of progression to end-stage renal failure.Nephrology Dial. Transplant. 1996;11:3:461–67. doi: 10.1093/ndt/11.3.461.
- The GISEN Group «GruppoItaiiano di StudiEpidemiologici in Nefrologia»:Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. Lancet.1997;349:1857–63. [PMID: 9407422].
- Левицкая Е.С., Батюшин М.М. Канальцевый аппарат почек – научное и прикладное значение. Архивъ внутренней медицины. 2022;12(6):405–21. doi: 10.20514/2226-6704-2022-12-6-405-421. [Levitskaya E.S., Batiushin M.M. Kidney Tubules – Scientific and Applied Value. Rus. Arch. Int. Med. 2022;12(6):405–21 (In Russ.)].
- Гасанов М.З. Саркопения у пациентов с хронической болезнью почек: распространенность, особенности патогенеза и клиническое значение. Нефрология, 2021;25(1):47–58. doi: 10.36485/1561-6274-2021-25-1-47-58. [Gasanov M.Z. Sarcopenia in patients with chronic kidney disease: prevalence, pathogenesis and clinical signifi cance. Nephrol. (Saint-Petersburg) 2021;25(1):47–58 (In Russ.)].
- Бобкова И.Н., Шестакова М.В., Щукина А.А. Диабетическая нефропатия - фокус на повреждение подоцитов. Нефрология. 2015;19(2):33–44. [Bobkova I.N., Shestakova M.V., Schukina A.A. Diabetic nephropathy - focus on podocytes damage. Nephrol. 2015;19(2):33–44 (In Russ.)].
- Румянцев А.Ш., Шишкин А.Н., Минкин С.Р., Шевелева М.А. Особенности кардиоренального континуума у пациентов с метаболическим синдромом. Нефрология. 2016;20(5):75–83. [Rumyantsev A.Sh., Shishkin A.N., Minkin S.R., Sheveleva M.A. Features of cardiorenal relationships in patients with metabolic syndrome. Nephrol. 2016;20(5):75–83 (In Russ.)].
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