Structural and Functional State of the Left Parts of the Heart in Chronic Kidney Disease Stage C4-C5

THE AIM: to analyze the state of the left heart in patients with chronic kidney disease (CKD) at stages C4 and C5 of the disease who do not receive renal replacement therapy. PATIENTS AND METHODS. 123 men and 81 women aged 16 to 74 years with CKD C4-C5 not receiving renal replacement therapy were examined. Patients underwent general clinical examination, electro- and echocardiography. The excretory function of the kidneys was evaluated by the formula CKD-EPI. results. Among the examined patients, 35 (28.4 %) men and 22 (27.1 %) women were found to be overweight. Arterial hypertension (AH) was recorded in 92 (74.7 %) men and 58 (71.6 %) women. An increase in the content of C-reactive protein in blood serum was observed in 28 men (22.7 %) and 19 women (23.4 %). 88.6 % of men and 91.3 % of women showed signs of anemia. Among the surveyed men and women, iron deficiency was observed in 17.8 and 18.5 %, respectively. Hypercholesterolemia was detected in 25.2 % of men and 23.4 % of women. Nephrotic proteinuria was significantly more common among males compared to women (21.1 % and 14.8 %, p<0.05). The prevalence of hyperuricemia was significantly higher in the examined women than in men (41.9 and 18.6 %, respectively, p<0.05). Cardiac conduction and/or excitability disorders were significantly more frequently reported among female patients compared to men (9.8 % and 4.8 %, p<0.05). Signs of subendocardial or subepicardial myocardial damage were detected in 2.4 % of men and 4.9 % of women. An increase in the size of the left atrium was significantly more often recorded in men (25.2 %) compared with women (16.0 %, p<0.05). A decrease in the left ventricular ejection fraction (LV) was recorded in 8.9 % of cases in men and 6.1 % in women. Men had a statistically significant increase in LP size (p<0.05) compared to female patients. In the subgroup of males, the final systolic and diastolic dimensions, LV wall thickness values, and LV myocardial mass index (LVMMI) were significantly higher (p<0.05) compared with female patients. In the studied subgroups of men and women, the most common type of LV structural adjustment was eccentric LV hypertrophy (69.9 % and 74.1 %, respectively), and concentric LV hypertrophy in the 1st and 2nd subgroups was detected in 30.1 % and 25.9 % of cases, respectively. In the subgroup of men, the level of systolic blood pressure (BP) (R2=24 %, β=0.449, p=0.003) and the concentration of hemoglobin (Hb) (R2=24 %, β = – 0.310, p=0.003) had a statistically significant effect on the value of LVH. In female patients, the level of diastolic blood pressure (R2=49 %, β=0.364, p=0.001) and the concentration of g (R2=49 %, β = –0.315, p=0.001) significantly influenced the LVMMI index. CONCLUSION. In patients with CKD at stages C4 and C5 of the disease, structural and functional changes of the heart are associated with hypertension, anemia, hyperuricemia and nephrotic proteinuria. The change in LV geometry is mainly represented by an eccentric type of hypertrophy. A more pronounced structural restructuring of the left parts of the heart is observed in males. The level of systolic blood pressure in men and diastolic blood pressure in women has a significant impact on the development of LV hypertrophy. The Hb concentration was a factor independent of gender, which had a significant effect on the value of LVMMI. 

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