Renal function in patients with cardiovascular disease and obesity

THE AIM. To study the renal function and the severity of insulin resistance (IR), followed by evaluation of the combined risk of progression of chronic kidney disease (CKD) and cardiovascular complications in patients with obesity and existing cardiovascular disease (CVD). PATIENTS AND METHODS. The study included 140 patients with CVD between the ages of 45 to 70 years. Patients were divided into four comparable in age, sex, smoking, presence / absence of arterial hypertension (AH) and chronic heart failure (CHF), duration of hypertension, functional class (FC) of CHF, the level of office systolic blood pressure (SBP) and diastolic blood pressure (DBP) groups depending on the body mass index (BMI). We assessed the general condition, the clini- cal measurement of the heart rate (HR), and office BP in both arms according to standard procedure, the definition of CHF FC on 6-minute walk test, anthropometry with BMI calculation, measurement of waist circumference (OT) and hip circumference (ON) and body composition by the bioelectric impedance analysis. We also determined proteinuria (PU), albuminuria (AU), calculated glomerular filtration rate (GFR). We analyzed the combined risk of CKD progression and cardiovascular complications, depending on the GFR and the AU. To assess the current IR we used index HOMA-IR, triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) ratio and the metabolic index (MI) with the use of carbohydrate and lipid parameters. RESULTS. There was a significant increase in the level of PU among patients group 4 compared to group 1 (560,19 ± 454,59 mg / g vs 330,8 ± 85,0 mg / g) and a statistically significant decrease in GFR in patients 3 and 4 groups compared with patients of group 1 (65,83 ± 13,39 and 64,06 ± 14,52 ml / min / 1.73 m 2, respectively, vs 74,94 ± 13,68 ml / min / 1.73 m2). Reliable average power detected correlation between the severity of visceral obesity and AU (r = 0,452), PU (r = 0,360), and GFR (r = -0,491). Analysis of the combined risk of CKD progression and cardiovascular complications showed a significant increase in very high-risk patients in the comparison group and 4 patients 1, 2 and 3 groups (68,6% vs 25, 39.8 and 40%, respectively). In assessing the indices that characterize the severity of IR, a statistically significant increase in HOMA-IR, TG / HSLPVP, MI with increasing BMI from group 1 to group 4 was established. We noted a high fidelity direct strong correlation between the level of visceral fat in the body, and HOMA-IR (r = 0,821), TG / HSLPVP (r = 0,806), MI (r = 0,812). CONCLUSION. The study showed a statistically significant progressive deterioration of renal function and an increase in the severity of IR as well as the increase in the combined risk of progression of CKD and cardiovascular events in patients with CVD with an increase in obesity during the comparable values of SBP office, DBP office and CHF FC among the studied groups. There were significant correlations between parameters of renal function and visceral obesity.

renal function, obesity, cardiovascular disease, chronic kidney disease

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