ECHOCARDIOGRAPHY INDICES IN PATIENTS WITH CHRONIC KIDNEY DISEASE AND THEIR DYNAMICS UNDER THE INFLUENCE OF SPIRONOLACTONE THERAPY
https://doi.org/10.24884/1561-6274-2008-12-1-40-45
Abstract
THE AIN of the work was to study the myocardium state in patients with CKD of the III-IV stages and the influence of spironolactone therapy. PATIENTS AND METHODS. The investigation included 46 patients with CKD of the III-IV stages and 83 patients with V stage CKD treated by program hemodialysis (HD). Spironolactone was given to 38 of them during 6 months (25 mg/day).The parameters of EchoCG under study included determination of the left ventzicle (LV) sizes, left ventricle myocardium mass (LVMM) by ASE formula, relative thickness of the left ventricle wall (RTW). Indexation of LVMM to the body surface area (ILVMM) was carried on. Hypertrophy and remodeling of LV was diagnosed at ILVMM 125 g/m² and more in men and 110 g/m² and more in women, increased RTW was estimated at values 0.45 and more. The remodeling type was determined according to current notions: normal geometry, concentric hypertrophy, eccentric hypertrophy and concentric remodeling. RESULTS. The dynamics of the left ventricle echographic parameters was shown under the influence of spironolactone in a group of patients taking spironolactone (1st group) and not taking spironolactone (2nd group): left atrium (LA) was 4.58±0.11 before spironolactone therapy and 4.4±011 after spironolactone therapy in the 1st group and 4.03±0.11 and 3.9±0.09 respectively in the 2nd group; FDS was 4.15±0.13 before spironolactone therapy and 3.94±0.17 after spironolactone therapy in the 1st group and 4.99±0.13 and 5.01±0.1 respectively in the 2nd group; TDWLV was 1.29±0.03 and 1.23±0.04 in the 1st group and 1.19±0.03 and 1.21±0.03 I the 2nd group; LVMM was 238.46±19.11 and 206.18±21.45 in the 1st group and 293.39±17.13 and 291.52±15.43 in the 2nd group, ILVMM was 132.2±10.81 and 113.32±11.75 in the 1st group and 173.57±10.47 and 176.94±10.06 in the 2nd group. CONCLUSION. Spironolactone therapy in dosage 25 mg/day in patients with anuria on hemodialysis results in a reliably decreased thickness of the posterior wall, mass and volume of the left ventricle myocardium and left atrium size.
About the Authors
A. M. EssaianRussian Federation
A. Zh. Karabaeva
Russian Federation
I. G. Kayukov
Russian Federation
References
1. US renal data system: USRDS 1999 annual data report National Institute of health, National Institute of diabetes and digestive and kidney disease. Bethesda, MD. 1999
2. Teraoka S, Toma H, Nihey H et al. Current status of renal replacement therapy in Japan. Am J Kidney Dis 1995; 25: 151-164
3. Бикбов БТ, Томилина НА. О состоянии заместительной терапии больных с хронической почечной недостаточностью в Российской Федерации в 2000 г. (Отчет по данным Российского регистра). Нефрология и диализ 2002; 3: 148-170
4. Багрий А.Э. Характеристика сердечно-сосудистых нарушений у больных с хронической почечной недостаточностью. Врач дело 1997; 3: 57-60
5. London GM. Cardiovascular disease in chronic renal failure: pathophysiologic aspects. Semin Dial 2003; 16 (2): 85-94
6. Epstein M. Aldosterone as a determinant of cardiovascular and renal dysfunction. J R Soc Med 2001 Aug; 94(8): 378-83
7. Rocha R, Stier CTJ, Kifor I et al. Aldosterone: a mediator of myocardial necrosis and renal arteriopathy. Endocrinology 2000; 141: 3871-3878
8. Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360: 1903–1913. MA
9. Liao Y, Cooper R, Mensah G et al. The relative effects of left ventricular hypertrophy, coronary artery disease, and ventricular dysfunction on survival among black adults. JAMA 1995; 273: 1592–1597
10. Schillaci G, Verdecchia P, Porcellati C et al. Continuous relation between left ventricular mass and risk in essential hypertension. Hypertension 2000; 35: 580–586
11. Stenvilken P, Wanner C, Metzger T et al. Inflamation and outcome in end-stage renal disease: impact of gender. Kidney Int 2002; 62: 1791-1798
12. Конради АО. Лечение артериальной гипертензии в особых группах больных. Гипертрофия левого желудочка. Артериальная гипертензия 2005: 2 (11)
13. Ringoir S. An update on uremic toxins. Kidney Int 1997; 52 (62): S2 – S4
14. Kasiske BL. Hyperlipidemia in patients with chronic renal failure. Am J Kidney Int 1998; 32 (3): 142-156
15. Kitiukara C, Gonin J, Masy Z et al. Non-traditional cardiovascular diseases risk factors in end-stage renal disease: oxidative stress and hyperhomocysteinemia. Current Opinion in Nephrol Hypertens 2000; 9(5): 477 – 487
16. Рыбакова МК, Коротченко НВ, Митьков ВВ, Шутов ЕВ. Доплерэхокардиография в исследовании центральной гемодинамики у диализных больных. Обзор литературы. Ультразвуковая диагностика 2000; 3: 112-120
17. Aristiralal D. Disparate structural effects on left and right ventricles by ACE-inhibitors and calcium antagonists in essential hypertension. Am J Cardiol 1994; 73: 483-487
18. Doba N, Tomiyama H, Vashida H. Left ventricular hypertrophy in mild essential hypertension, its progression, prediction and treatment strategy. Jap Heart J 1996; 37: 417-430
19. Шляхто ЕВ, Конради АО, Захаров ДВ, Рудоманов ОГ. Структурно-функциональные изменения миокарда у больных гипертонической болезнью. Кардиология 1999; 2: 49-55
20. Cunha DM, Cunha AB, Martins WA et al. Echocardiographic assessment of the different left ventricular geometric patterns in hypertensive patients. Arg Bras Cardiol 2001; 76(1): 15-28
21. Исаков АП, Выжимов ИА. Ремоделирование левого желудочка у больных артериальной гипертонией. Клин медицина 2006; 5: 38-41
22. Грачев АВ, Аляви АЛ, Ниязова ГУ, Мостовщиков СБ. Масса миокарда левого желудочка, его функциональное состояние и диастолическая функция сердца у больных артериальной гипертонией при различных типах геометрии левого желудочка сердца. Кардиология 2000; 3: 31-38
23. Шляхто ЕВ, Конради АО. Роль генетических факторов в ремоделировании сердечно-сосудистой системы при гипертонической болезни. Артериальная гипертензия 2002; 3(4): 22-29
24. Kosmala W, Przenloska-Kosmala M, Zysko D, Halawa B. Relations between neurohormonal factors and left ventricular mass in patients with essential hypertension. Eur Heart J 1998; 19: Abstact: Suppl. 419
25. Yotova V, Katova T, Torbova S et al. The left ventricular geometric patterns in hypertensive patients identify the differences of depressed systolic function. Eur Heart J 1996; 17: Abstract: Suppl. 47
26. Лещинский ЛА, Мультановский БЛ, Пономарев СБ, Петров АГ. Артериальная гипертония и ишемическая болезнь сердца: клинико-эхокардиографические аспекты. Клин медицина 2003; 11: 42-46
27. Шипилова Т, Пшеничников И, Волож О и др. Определение массы миокарда левого желудочка и его геометрии по данным эхокардиографии в популяционном исследовании женщин Таллина. Кардиология 2002; 11: 52-56
28. Krumholz HM, Larson M, Levy D. Prognosis of left ventricular geometric patterns in Framingham Heart Study. J Am Coll Cardiol 1995; 25: 884–897
29. Штегман ОА, Терещенко ЮА. Систолическая и диастолическая дисфункции левого желудочка – самостоятельные типы сердечной недостаточности или две стороны одного процесса? Кардиология 2004; 2: 82-86
30. Yu C-M, Lin H, Yang H et al. Progression of systolic abnormalities in patients with «isolated» diastolic heart failure and diastolic dysfunction. Circullation 2002; 105: 1195-1201
Review
For citations:
Essaian A.M., Karabaeva A.Zh., Kayukov I.G. ECHOCARDIOGRAPHY INDICES IN PATIENTS WITH CHRONIC KIDNEY DISEASE AND THEIR DYNAMICS UNDER THE INFLUENCE OF SPIRONOLACTONE THERAPY. Nephrology (Saint-Petersburg). 2008;12(1):40-45. (In Russ.) https://doi.org/10.24884/1561-6274-2008-12-1-40-45