[Risk factors for cardiovascular system damage in chronic kidney disease].

AIM: To study the prevalence of and risk factors (RF) associated with cardiovascular system damage in patients with predialysis diabetic and nondiabetic chronic kidney disease (CKD). SUBJECTS AND METHODS: The investigation enrolled 317 patients with CKD of various etiologies. In Group 1 (165 patients with CKD: 54% of men, 46% of women; mean age 46 +/- 15 years), the glomerular filtration rate (GFR) was 37.2 ml/min; the serum creatinine level was 2.9 mg/dl. Group 2 included 152 (41%) patients with type 2 diabetes mellitus (DM) (41% of men and 59% of women; mean age 57.3 +/- 7.1 years). The duration of DM averaged 10.4 +/- 7.1 years. All the patients underwent physical examination; the levels of glycated hemoglobin and adipose tissue hormones, urinary albumin excretion were additionally determined in the diabetic patients. Echocardiography was performed in 172 patients. The influence of populationwide and renal failure-associated RFs on the cardiovascular system was evaluated in CKD. RESULTS: Clinical and instrumental examinations of 165 patients with Stages II-IV nondiabetic CKD revealed atherosclerosis of the aorta and the vessels of the heart, brain, kidney, and lower extremities in 60 (37%), 35 (24%), 30 (18%), 23 (14%), and 8 (5%), respectively. As atherosclerotic vascular lesion progressed, the incidence of cardiovascular events (CVE) increased. Left ventricular hypertrophy (LVH) was diagnosed in 37.3% of the patients with nondiabetic CKD. Along with traditional cardiovascular RFs (age, smoking, gender, arterial hypertension), the renal dysfunction-related factors (anemia, diminished glomerular filtration rate, elevated creatitine levels, and abnormal phosphorus and calcium metabolism) are of importance. An association was found between LVH, atherosclerotic vascular lesion, and heart valve calcification. According to EchoCG data, 36% of the patients with type 2 DM were diagnosed as having LVH. The RFs of the latter were albuminuria, obesity, and abnormal carbohydrate and purine metabolisms. There was an association of diabetic nephropathy with left ventricular remodeling processes and a history of CVE. CONCLUSION: The development of cardiorenal syndrome is observed in early-stage CKD and related to both traditional and renal RFs.

[The role of hyperinsulinemia and insulin resistance in development of chronic kidney disease in patients with metabolic syndrome].

AIM: To examine relations between hyperinsulinemia, insulin resistance (IR). components of metabolic syndrome (MS) and predisposition to renal damage, MATERIAL AND METHODS: A total of 94 MS patients (64 males and 30 females, age 30-67 years, mean age 52 +/- 9 years) entered the study. The examination included measurement of waist and hip circumference, body mass index (BMI), HOMA index, estimation of lipids and immunoreactive insulin concentrations. Renal damage was assessed by glomerular filtration rate and urinary excretion of albumin. The patients were divided into groups by IR and BMI. RESULTS: A strong correlation was found between IR markers and lipid metabolism disorders, hemodynamic parameters. Statistics show that IR is an independent unfavourable factor of renal damage in MS patients. CONCLUSION: IR is an essential component of MS and an independent factor of development of chronic kidney disease in MS patients.

[The role of lipid metabolism disorders in kidney disease in metabolic syndrome associated with obesity].

AIM: To study the role of lipid metabolism impairment in renal disease in patients with metabolic syndrome associated with obesity. MATERIAL AND METHODS: Lipid metabolism was studied in 77 patients with metabolic syndrome (MS) aged from 17 to 63 years (mean age 48 +/- 9 years). Lipid abnormalities were analysed in groups of patients with different degree of obesity: group 1 - body mass index (BMI) 25-29.9 kg/m2 (n = 13), group 2 - BMI 30-39.9 kg/m2 (n = 49), group 3 - BMI > 40 kg/m2 (n = 15), and in groups of patients with different insulin resistance (IR) : group 1 - HOMA-IR < 2; n = 12; group 2 - HOMA-IR 2 - 4; n = 27; group 3 HOMA-IR > 4; n = 32). Correlation between plasma lipid composition abnormalities and markers of renal disease were studied with correlation analysis. RESULTS: Lipid disbolism in MS patients was characterized with elevated level of triglycerides, total cholesterol (TC), VLDLP cholesterol, low level of HDLP cholesterol. A significant relationship was detected between defective blood lipid composition and renal dysfunction: rise of microalbuminuria, proteinuria, creatinin, inhibition ofglomerular filtration rate. CONCLUSION: The changes found characterize lipid metabolism disorder as an independent factor of kidney disease in patients with MS.

[Contribution of obesity to renal lesions in patients with type 2 diabetes mellitus].

AIM: To study of the contribution of obesity to renal lesion in patients with type 2 diabetes mellitus (T2DM). SUBJECTS AND METHODS: One hundred and fifty-four patients (62 males and 92 females) with T2DM (mean age 58 +/- 8 years) were examined. The study excluded patients with significant stages of diabetic nephropathy (glomerular filtration rate (GFR) < 60 ml/min; proteinuria more than 2 g/day). Anthropometric indicators, such as body mass index (BMI), were estimated. The serum levels of creatinine, uric acid (UA), lipid composition, and the adipose tissue hormones leptin and adiponectin were measured. Renal lesion was evaluated from GFR and urine albumin excretion level. Groups of patients with a less and more than 5-year history and subgroups of a MBI of less and more than 30 kg/mi were identified. RESULTS: In patients with a more than 5-year history of T2DM, the detection rate of microalbuminuria and proteinuria increased as obesity progressed. This regularity was not found in those with a less than 5-year history of T2DM. Diabetic patients with a BMI of > 30 kg/m2 were more frequently found to have intrarenal hemodynamic disorders (hyperfiltration) elevated blood pressure, increased UA, and decreased high-density lipoproteins, as compared with those with a BMI of < 30 kg/m2. With a higher BMI, leptin levels increased; its highest values were found in a group of patients with proteinuria. Hypoadiponectinemia was detected in most patients with T2DM. Adiponectin was decreased in early-stage nephropathy; its increase was further increased. CONCLUSION: There was a greater prevalence of renal lesion in obese (BMI > 30 kg/m2) patients with a more than 5-year history of T2DM than in non-obese patients. Obesity has an impact on renal function due to its hemodynamic, metabolic, and hormonal effects.

[Lisinopril: antihypertensive activity, effects on heart rhythm variability and carbohydrate metabolism in patients with metabolic syndrome].

AIM: To examine antihypertensive activity, heart rate variability (HRV) and carbohydrate metabolism of ACE inhibitor lisinopril in patients with metabolic syndrome (MS). MATERIAL AND METHODS: Twenty MS patients (13 females and 7 males) received lisinopril monotherapy for 12 weeks. Before the treatment and after 12 weeks of lisinopril treatment the following tests were made: office measurement of blood pressure (BP), 24-hour BP monitoring, exercise test, investigation of HRV and carbohydrate profile. RESULTS: A 12-week treatment with lisinopril had high antihypertensive efficacy, its positive action on HRV and carbohydrate metabolism manifested in reduction of postprandial glycemia and insulinemia.

[Efficacy of combined antihypertensive treatment with amlodipine and lisinopril in metabolic syndrome].

AIM: To assess efficacy of monotherapy with ACE inhibitor lisinopril (diroton) or calcium antagonist amlodipine (normodipine) and their combination in patients with metabolic syndrome (MS). MATERIAL AND METHODS: The study enrolled 42 patients (30 females, 12 males) with MS. The examination at baseline and after 12 weeks of treatment included office blood pressure (BP) measurement, 24-hour BP monitoring, heart rate variability (HRV) and carbohydrate profiles estimation. RESULTS: In moderate hypertension BP normalized in 40 and 44% on monotherapy with lisinopril or amlodipine, respectively, and in 78% patients given lisinopril+amlodipine. The latter combination and lisinopril monotherapy had a positive effect on HRV parameters. Lisinopril monotherapy improved carbohydrate metabolism as shown by reduction of postprandial hyperglycemia and hyperinsulinemia in MS patients. CONCLUSION: Combined treatment with amlodipin and lisinopril is more effective than monotherapy with each of the above drugs.

[Effects of amlodipine on blood pressure. Results of cardiovascular tests and heart rate variability in patients with metabolic syndrome].

AIM: To study effects of calcium antagonist amlodipine (normodipine) on blood pressure, heart rate variability (HRV) and carbohydrate metabolism in patients with metabolic syndrome (MS). MATERIAL AND METHODS: The trial included 52 patients (37 females, 15 males) with MS. The examination at baseline and after 12 weeks of amlodipine treatment included: office blood pressure (BP) measurement, 24-h BP monitoring, exercise tolerance test, estimation of HRV and carbohydrate profile. Amlodipine was administered as monotherapy for 12 weeks. RESULTS: A 12-week treatment with amlodipine demonstrated high antihypertensive effect (BP normalized in 72.7% patients) without negative effects on HRV and carbohydrate profile. CONCLUSION: Monotherapy with calcium antagonist amlodipine (normodipine) has high antihypertensive efficacy and is metabolically neutral in MS patients.