Журнал "Почки" том 9, №3

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Îðèã³íàëüí³ ñòàòò³Original ArticlesUDC 616.1:616.61-008.64-036.12-085.25 DOI: 10.22141/2307-1257.9.3.2020.211459Î.N. Sharapov 1, 2 , B.T. Daminov 1, 2 , S.V. Yarygina 31Tashkent Pediatric Medical Institute, Tashkent, the Republic of Uzbekistan2Republican Specialized Scientific Practical Medical Center of Nephrology and Kidney Transplantation, Tashkent,the Republic of Uzbekistan3Republican Specialized Scientific and Practical Medical Center of Urology, Tashkent, the Republic of UzbekistanCardiovascular pathologies in the urban populationof the Republic of Uzbekistan with chronic kidneydisease on hemodialysisAbstract. Background. Chronic kidney disease (CKD) is now an undeniable global public priority. Althoughthe prevalence and health effects of CKD have been studied primarily in economically developed countries,the burden of the disease is even greater in developing countries. For this purpose, we decided tostudy the structure of cardiovascular pathologies in patients with stage 5 chronic kidney disease receivingprogrammed hemodialysis of the urban population. Materials and methods. In the course of the scientificstudy, 104 patients permanently residing in the city of Tashkent were examined. The average age of thepatients was 49.7 ± 11.7 years. The study included patients with a clinically established diagnosis of stage5 CKD due to nephropathies of various origins. Glomerular filtration rate was calculated based on serumcreatinine concentration using the CKD-Epi formula. Hemodialysis sessions were carried out according tothe scheme 4 hours 3 times a week. Results. According to the results of a study of 104 patients, 62 (59.6 %)of the examined had cardiovascular pathology. The most frequent occurrence was arterial hypertension,almost 53 % (n = 55) of patients suffered from it. Stable angina was detected in 38.5 % patients (n = 40).Chronic heart failure was found in more than 19 % (n = 20) of patients. Conclusions. The results of the analysisof 104 CKD patients on hemodialysis demonstrated that the main pathologies of the cardiovascularsystem in urban patients were chronic heart failure, arterial hypertension, angina, and various arrhythmias.It can be assumed that the comorbid pathology of the cardiovascular system dominates in the structureof cardiovascular lesions in patients with end-stage chronic kidney disease receiving programmed hemodialysisand is not sex-related. It also may be noted the high incidence of diabetes mellitus in the examinedpatients with cardiovascular disease, which corresponds to the literature data.Keywords: chronic kidney disease; hemodialysis; cardiovascular system; arterial hypertension; angina;chronic heart failureIntroductionIn a recently published joint report by the EuropeanRenal Association-European Dialysis and TransplantAssociation, American Society of Nephrology, and InternationalSociety of Nephrology, kidney diseases wererecognized as one of the most common diseases in theworld [1]. According to this report, globally, the totalnumber of people with chronic kidney disease (CKD),acute kidney injury and people receiving renal replacementtherapy exceeds 850 million, which is actuallytwice the estimated number of patients with diabetesmellitus around the world and 20 times higher than thenumber of people suffering from acquired immunodeficiencysyndrome/human immunodeficiency virus© «Нирки» / «Почки» / «Kidneys» ( ), 2020© Видавець Заславський О.Ю. / Издатель Заславский А.Ю. / Publisher Zaslavsky O.Yu., 2020Для корреспонденции: Шарапов Олимхон Надирханович, докторант Ташкентского педиатрического медицинского института, врач-нефролог, Республиканский специализированный научно-практическиймедицинский центр нефрологии и трансплантации почки, ул. Богишамол, 223, Юнусабадский район, 100140, г. Ташкент, Республика Узбекистан, факс: (998) 71-260-36-58; e-mail: olimkhon@gmail.com; контактный тел.: +998 90 9722508.For correspondence: Olimkhon Sharapov, nephrologist, PhD student of the Tashkent Pediatric Medical Institute, Republican Specialized Scientific and Practical Medical Center of Nephrology and KidneyTransplantation, Bogishamol st., 223, Yunusabad district, 100140, Tashkent, the Republic of Uzbekistan, fax: (998) 71-260-36-58; e-mail: olimkhon@gmail.com; phone: +998 90 9722508.Full list of author information is available at the end of the article.12 Íèðêè, ISSN 2307-1257 (print), ISSN 2307-1265 (online) Òîì 9, ¹ 3, 2020
Îðèã³íàëüí³ ñòàòò³ / Original Articlesworldwide. CKD is currently an undeniable global publicpriority [2, 3].Despite the fact that the prevalence of CKD and its effectson health have been studied mainly in economicallydeveloped countries, the burden of this disease is evengreater in developing countries [4, 5].The risk of cardiovascular complications increases inverselywith the level of glomerular filtration rate (GFR),and with GFR < 30 ml/min exceeds that with preservedrenal function 5.5 times. A significant number of patientswith CKD die due to cardiovascular complications evenbefore the end-stage renal disease [6].In patients with essential arterial hypertension (AH)without any cardiovascular complications, a moderatedecrease in GFR is accompanied by a doubling of therisk of cardiac death. International recommendations onhypertension unconditionally recognize microalbuminuria(MAU) and a decrease in GFR as some of the mainrisk factors for the progression of cardiovascular disease[7, 8].Besides, it turned out that in the general populationaged 45–74 years, a decrease in GFR below 60 ml/minacts as an independent risk factor for acute myocardial infarction,general and cardiovascular mortality [9].Also, to date, a lot of literature has been accumulatedon the role of proteinuria, MAU in the progression of renalpatho logy and cardiovascular disease (CVD) [10, 11]. Infact, the prevalence of albuminuria, both micro- and macro-,increases with a drop in GFR < 60 ml/min/1.73 m 2[12]. MAU is believed to reflect the presence of generalizedendothelial dysfunction in the body, which, in turn,is the cause of accele rated atherogenesis and progressionof renal fibrosis [13].Scientific research is widely conducted to study theplace of ischemic heart disease (IHD) in the structure ofCVD and its course in patients with CKD [14, 15]. So, in aprospective study of V.A. Dobronravov et al. (2002–2009),a detailed long-term clinical analysis of the course ofmyocardial ischemia (MI) was performed in 119 patientson hemodialysis. At the time of inclusion in the study,clinical signs of MI were detected in 60 (50.4 %) patients,of which typical angina pectoris in 52 %, painless MI in23 % (the prevalence of painless MI was even greater thanin patients with diabetes mellitus and was likely to be dueto the presence of neuropathy against the background ofpersistence of uremia, as well as damage to the intramyocardialarteries), a mixed form in 25 %. Among 66 out of119 patients who had cardiovascular events, mortality was59 %, the total proportion of patients with some form ofMI was 86 %, and MI progression was observed in 82 %.In 35 % of the latter, clinical signs of coronary insufficiencyfirst appeared during the observation period. Anunexpected result of the work was also the discovery of theassociation of higher values of troponin T (TnT) with thepresence of MI signs at the time of inclusion of patientsin the study. Since cases of acute coronary syndrome inpatients were completely excluded at the beginning of aprospective observation, the authors suggested that thismarker reflects the development of deeper chronic damageto myocardiocytes caused by MI in dialysis patients.This indicator was also an independent predictorof death from CVD: at TnT > 0.05 ng/ml, the relative riskof cardiac death increased 5 times. Also, the relationshipbetween a decrease in diastolic blood pressure on the firstpost-dialysis day, a higher level of plasma homocysteineand the progression of MI was shown. Considering thedata obtained, the authors indicate the need for a thoroughexamination of patients for the presence of MI atthe beginning of renal replacement therapy or when planningit. Moreover, the onset or progression of coronaryheart disease is characteristic of the early period after theonset of hemodialysis [15].A number of studies have investigated the frequencyof valve calcification in patients with CKD: calcificationof heart valves among dialysis patients occurs in 20–78 %cases and calcification of the mitral valve fibrous ring in31–46 %. According to M.M. Volkov et al., at the predialysisstage of CKD, valve calcification was detected in22.1 % of patients. Thus, the frequency of valve calcificationincreases with the CKD progression, reaching amaximum in the dialysis population [16].The studies have also investigated the problems of cardiovascularlesions in patients with CKD on hemodialysisin different populations. In particular, the urban and ruralpopulation was studied and distinctive data have been obtainedthat show the relevance of studying this problem[17].The purpose of the study was to investigate the structureof cardiovascular pathologies in patients with stage 5chronic kidney disease receiving programmed hemodialysisof the urban population of the Republic of Uzbekistan.Materials and methodsDuring the scientific study, there were examined 104patients permanently residing in the city of Tashkent.The study was conducted in hemodialysis departmentsof the Republican Specialized Scientific and PracticalMedical Center of Nephrology and Kidney Transplantationand the Republican Specialized Scientific and PracticalMedical Center of Urology during 2018. Forty-nineper cent (n = 51) of the examined patients were men and51 % (n = 53) were women. The average age of the patientswas 49.7 ± 11.7 years. The study included patientswith a clinically established diagnosis of CKD stage 5(according to NKF KDOQI 2002) in the outcome ofnephropathies of various origins. Glomerular filtrationrate was calculated based on the serum creatinine concentrationaccording to the formula CKD-Epi. The classificationof blood pressure levels and the definition ofhypertension were determined according to the Recommendationsfor the management of arterial hypertensionof the European Society of Cardiology and the EuropeanSociety of Arterial Hypertension of 2018 [18]. The mainunderlying diseases were chronic glomerulonephritis(n = 38), diabetes mellitus (n = 33), urolithiasis (n = 11),systemic vasculitis (n = 5), developmental abnormalitiesand pathology of the urinary tract (n = 5), chronic pyelonephritis(n = 4), systemic lupus erythematosus (n = 2),Òîì 9, ¹ 3, 2020www.mif-ua.com, http://kidneys.zaslavsky.com.ua 13
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Page 5 and 6: Editor-in-ChiefDmytro D. IvanovKidn
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Журнал "Почки" том 9, №3

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